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Evaluation and management of postfundoplication dysphagia
J M Wo1, T L Trus, W S Richardson
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
The American Journal of Gastroenterology
|November 1, 1996
Summary
Endoscopic dilation is a safe treatment for postfundoplication dysphagia. Success rates are higher for intact fundoplications compared to slipped ones, with multiple prior surgeries reducing effectiveness.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Endoscopic Procedures
Background:
- Persistent dysphagia affects 3-24% of patients post-fundoplication.
- Limited data exists on endoscopic dilation for postfundoplication dysphagia.
Purpose of the Study:
- To review the experience with endoscopic management of dysphagia after fundoplication.
- To evaluate the safety and efficacy of endoscopic dilation in this patient population.
Main Methods:
- Retrospective review of 35 patients undergoing endoscopic dilation for postfundoplication dysphagia.
- Patients categorized into one (Group A) or multiple (Group B) prior fundoplications.
- Fundoplication integrity assessed via barium esophagram and upper endoscopy; median follow-up was 13 months.
Main Results:
- Endoscopic dilation was performed safely with no complications or new reflux symptoms.
- Dysphagia resolved in 52% of patients overall.
- Success rates were significantly higher in patients with intact fundoplications (67%) versus slipped fundoplications (27%).
- Patients with multiple prior fundoplications had poor response rates.
Conclusions:
- Endoscopic dilation is a safe and often effective treatment for postfundoplication dysphagia.
- Fundoplication integrity is a key prognostic factor for successful dilation.
- Patients with slipped or multiple prior fundoplications have suboptimal outcomes with endoscopic dilation.