Endoscopy and Antireflux Surgery: A Technical Review of Pre- and Postoperative Evaluation and Recognizing Patterns of Failure

C. Dunn, Sven E. Eriksson, B. Jobe, S. Ayazi
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Abstract

Endoscopic evaluation after antireflux surgery is a challenge, due to the complexity of anatomy, variations in anatomical repairs, and the various patterns of failure. Studies have demonstrated that endoscopy reports of postoperative examinations are often inaccurate and inconsistent. The key to consistent high quality endoscopic examinations of the integrity of an antireflux surgery is a sound foundation in the native anatomical gastroesophageal junction and an understanding of the anatomy of the various postoperative configurations. This review will clarify the critical details necessary to perform a detailed endoscopic evaluation of the patient with suspected gastroesophageal reflux, and highlight key features to distinguish the intact repair from the dysfunctional one. It first explores the anatomical components of the native gastroesophageal junction and the unique geometric architecture that manifests in the physiologic reflux barrier. Then details the essential structures to evaluate and techniques to perform in an endoscopic examination prior to an antireflux surgery. It then systematically examines the altered anatomy and postoperative changes in endoscopic appearance after Nissen, Toupet, and Dor fundoplication, Collis gastroplasty, magnetic sphincter augmentation, and transoral incisionless fundoplication. Finally, to aid in the endoscopic diagnosis of specific dysfunction, it discusses the various patterns of failure after antireflux surgery, their characteristic endoscopic appearances, and the most useful adjunct testing modalities to augment the endoscopic examination when diagnosis is unclear.
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内镜和抗反流手术:术前和术后评估和识别失败模式的技术综述
由于解剖结构的复杂性、解剖修复的变化和各种失败模式,抗反流手术后的内镜评估是一项挑战。研究表明,内镜术后检查报告往往不准确和不一致。对抗反流手术完整性进行一致的高质量内窥镜检查的关键是对胃食管连接的天然解剖的良好基础和对各种术后构型的解剖理解。本综述将阐明对疑似胃食管反流患者进行详细内镜评估所需的关键细节,并强调区分完整修复与功能障碍修复的关键特征。它首先探讨了天然胃食管交界处的解剖成分和独特的几何结构,体现在生理性反流屏障中。然后详细介绍在抗反流手术前进行内窥镜检查时需要评估的基本结构和技术。然后系统地检查了Nissen, Toupet和Dor底瓣置换术、Collis胃成形术、磁力括约肌增强术和经口无切口底瓣置换术后解剖结构的改变和内镜下外观的术后变化。最后,为了帮助内镜诊断特定功能障碍,本文讨论了抗反流手术后失败的各种模式,它们的特征性内镜表现,以及在诊断不明确时增强内镜检查的最有用的辅助检测方式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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