PMID- 17345143
OWN - NLM
STAT- MEDLINE
DCOM- 20071003
LR  - 20181113
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 21
IP  - 10
DP  - 2007 Oct
TI  - Endoscopic ultrasound for the evaluation of Nissen fundoplication integrity: a 
      blinded comparison with conventional testing.
PG  - 1719-25
AB  - BACKGROUND: For patients whose symptoms develop after Nissen fundoplication, the 
      precise mechanism of anatomic failure can be difficult to determine. The authors 
      have previously reported the endosonographic hallmarks defining an intact Nissen 
      fundoplication in swine and the known causes of failure. The current clinical 
      trial tested the hypothesis that a defined set of endosonographic criteria can be 
      applied to determine fundoplication integrity in humans. METHODS: The study 
      enrolled seven symptomatic and nine asymptomatic subjects at a mean of 6 years 
      (range, 1-30 years) after Nissen fundoplication. A validated gastroesophageal 
      reflux disease (GERD)-specific questionnaire and medication history were 
      completed. Before endoscopic ultrasound (EUS), all the patients underwent 
      complete conventional testing (upper endoscopy, esophagram, manometry, 24-h pH). 
      A diagnosis was rendered on the basis of combined test results. Then EUS was 
      performed by an observer blinded to symptoms, medication use, and conventional 
      testing diagnoses. Because EUS and esophagogastroduodenoscopy (EGD) are uniformly 
      performed in combination, the EUS diagnosis was rendered on the basis of 
      previously established criteria combined with the EGD interpretation. The 
      diagnoses then were compared to examine the contribution of EUS in this setting. 
      RESULTS: The technique and defined criteria were easily applied to all subjects. 
      All symptomatic patients had heartburn and were taking proton pump inhibitors 
      (PPI). No asymptomatic patients were taking PPI. All diagnoses established with 
      combined conventional testing were detected on EUS with upper endoscopy. 
      Additionally, EUS resolved the etiology of a low lower esophageal sphincter 
      pressure in two symptomatic patients and detected the additional diagnoses of 
      slippage in two subjects. Among asymptomatic subjects, EUS identified additional 
      diagnoses in two subjects considered to be normal by conventional testing 
      methods. CONCLUSION: According to the findings, EUS is a feasible method for 
      evaluating post-Nissen fundoplication hiatal anatomic relationships. The 
      combination of EUS and EGD allows the mechanism of failure to be detected in 
      patients presenting with postoperative symptoms after Nissen fundoplication.
FAU - Chang, E Y
AU  - Chang EY
AD  - Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
FAU - Minjarez, R C
AU  - Minjarez RC
FAU - Kim, C Y
AU  - Kim CY
FAU - Seltman, A K
AU  - Seltman AK
FAU - Gopal, D V
AU  - Gopal DV
FAU - Diggs, B
AU  - Diggs B
FAU - Davila, R
AU  - Davila R
FAU - Hunter, J G
AU  - Hunter JG
FAU - Jobe, B A
AU  - Jobe BA
LA  - eng
GR  - K23 DK066165-02/DK/NIDDK NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20070308
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - *Endoscopy, Gastrointestinal
MH  - Female
MH  - Fundoplication/*methods
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Single-Blind Method
MH  - *Ultrasonography, Interventional
EDAT- 2007/03/09 09:00
MHDA- 2007/10/04 09:00
CRDT- 2007/03/09 09:00
PHST- 2006/11/03 00:00 [received]
PHST- 2006/11/20 00:00 [accepted]
PHST- 2006/11/03 00:00 [revised]
PHST- 2007/03/09 09:00 [pubmed]
PHST- 2007/10/04 09:00 [medline]
PHST- 2007/03/09 09:00 [entrez]
AID - 10.1007/s00464-007-9234-8 [doi]
PST - ppublish
SO  - Surg Endosc. 2007 Oct;21(10):1719-25. doi: 10.1007/s00464-007-9234-8. Epub 2007 
      Mar 8.