Endoscopic Evaluation of Post-Fundoplication Anatomy and Correlation With Symptomatology

Abstract

Background: Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. Aim: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. Method: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). Results: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). Conclusion: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

Prevalência dos achados endoscópicos em Sergipe

“…Foi evidenciada também uma maior prevalência de esofagopatias no gênero masculino (27,5%), apesar das mulheres realizarem mais EDA (80,1%), diferindo da amostra estudada em que o gênero feminino apresentou predomínio das impressões diagnósticas de esofagopatias Oliveira (2021). avaliou 2810 endoscopias e obteve predominância do sexo masculino com 16,68% dos casos de esofagopatias, diferindo também do presente estudo.No que tange os achados endoscópicos após realização de fundoplicatura,Martins et al (2020) verificou a prevalência de 4% de hernia hiatal paraesofágica, análogo ao presente trabalho. Além disso,Vicente et al (2009) constatou que a patologia de maior incidência em pacientes após fundoplicatura foi esofagite não erosiva, correspondendo a 11,2% dos pacientes, contrastando com os resultados obtidos que evidenciou a gastrite leve como o achado patológico mais prevalente.…”