Early contrast esophagram after anti-reflux surgery: use, perceived value, and impact on discharge among foregut...

Early postoperative esophageal contrast studies after anti-reflux and foregut surgery are used variably, and the value of routine testing remains uncertain. This study surveyed foregut surgeons regarding practice patterns, indications, perceived yield, and discharge impact of early contrast imaging.

An anonymous web-based questionnaire was distributed through an institutional listserv, the Society of American Gastrointestinal and Endoscopic Surgeons Foregut and Flexible Endoscopy Committees, and the American Foregut Society DocMatter community. Respondents reported practice characteristics, procedure-specific use of early (< 72 h) contrast imaging, indications for selective imaging, perceived management impact, and discharge consequences. Responses were summarized with descriptive statistics.

Sixty-six surgeons responded, 97% performed foregut surgery. Most practiced in academic or hybrid settings (77%) and were fellowship trained in minimally invasive surgery (59%) and/or foregut/advanced gastrointestinal surgery (63%). Intraoperative endoscopy was used always or most of the time by 79%. Routine early contrast imaging was uncommon after primary procedures, including sliding hiatal hernia repair (22%), paraesophageal hernia repair (28%), complete fundoplication (23%), partial fundoplication (23%), magnetic sphincter augmentation (26%), consecutive transoral incisionless fundoplication (30%), and Roux-en-Y gastric bypass (30%). Redo anti-reflux surgery prompted more frequent testing, with 44% reporting routine imaging. Leading triggers for selective imaging were intraoperative concern or injury (88%), early oral intolerance or dysphagia (69%), and atypical anatomy (46%). Most respondents (81%) estimated that only 0-5% of studies changed management. When management changed, diet modification (41%) and return to the operating room (30%) were most common. Thirty percent reported discharge delays in > = 10% of patients, usually by 6-24 h.

Routine early contrast imaging after anti-reflux surgery is uncommon among foregut specialists and is usually reserved for redo operations or specific clinical concerns. Respondents perceived low actionable yield and discharge delays in a subset of patients, supporting selective use in straightforward cases.