ENDOSCOPIC ASSESSMENT OF FAILED FUNDOPLICATIONS IS DEFINITIVELY DIFFERENT BETWEEN ENDOSCOPISTS
Andrés R. Latorre-Rodríguez*2, Peter Kim1, Sumeet K. Mittal2,1
1Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ; 2Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
ABSTRACT
Background: Fundoplication is widely used as a definitive treatment for gastroesophageal reflux disease (GERD); however, from 5-10% of patients may need re-intervention. Endoscopic assessment is critical in determining the pattern of failure and planning the surgical re-operative intervention and is almost always undertaken by the operating surgeon. Before referral to centers of expertise, patients usually undergo esophagogastroduodenoscopy (EGD) by the referring physician. We aimed to compare EGD findings between the external endoscopist and the operating surgeon.
Methods: After IRB approval, we conducted a retrospective chart review of patients who underwent redo-surgery by a single surgeon at our center after prior fundoplication. The EGD findings of the external endoscopist and operating surgeon were extracted from patient charts. Descriptive statistics, as well as Fisher's exact test, were applied as appropriate. A p-value <0.05 was considered statistically significant.
Results: We identified 87 patients who underwent re-operative antireflux surgery, of which 78 (17 males, 61 females) had both EGD reports. The median age was 61 years (IQR 53-69), and the median BMI was 28.7 kg/m2 (IQR 25.2-32.7). The median time between primary fundoplication and reoperation was 67 months (IQR 31-144.5) and that between external and internal EGDs was 4 months (IQR 2-13). Only 42% of external endoscopists documented the presence of fundoplication or prior surgery. Compared to the operating surgeon, external endoscopists reported a significantly lower proportion of Barrett's esophagus (61%, P < 0.01), slipped fundoplications (36%, P < 0.001), paraesophageal hernia (21%, P <0.001), intrathoracic fundoplications (0%, P < 0.01), and twisted fundoplications (0%, P < 0.001). No statistically significant differences were found between the reports of esophagitis, disrupted fundoplications, two-compartment stomachs, and large hiatal hernias.
Conclusions: Unfortunately, most EGD reports by external endoscopists in patients with a prior fundoplication did not include even a mention of previous surgery, let alone an accurate description of anatomical changes that are relevant for appropriate surgical planning. The findings of this study reaffirm the need to implement the standard use of classifications and include specific training within educational programs.
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