Pub Date : 2023-06-01DOI: 10.1177/26345161231170426
Salih Samo
To the editor, I read with great interest the article “The American Foregut Society white paper on the endoscopic classification of esophagogastric junction integrity”1 published in the journal. The newly proposed American Foregut Society (AFS) classification to grade the antireflux barrier (ARB) integrity provides more comprehensive evaluation that are relevant to the practicing clinicians in day-to-day practice. The authors appropriately call for future validation of this novel classification and its correlation with the presence and severity of gastroesophageal reflux disease, and additionally to extend the classification to assess the ARB integrity in individuals with prior antireflux interventions,1 whether surgical or endoscopic. However, the future directions fall short of addressing 2 important variables that may affect the assessment of ARB integrity by applying the AFS classification. First, the classification does not take into consideration the anesthesia effect on the ARB. The hiatal aperture tends to be larger under general anesthesia with use of paralytics as compared to conscious sedation without the use of paralytics. Second, the novel AFS classification does not take obesity into consideration either. It is common to see a large fat pad in the diaphragmatic hiatus during laparoscopy, which may prevent accurate appreciation of a hidden hiatal hernia, whether endoscopically or laparoscopically. Therefore, caution needs to be taken when evaluating for hiatal hernia in obese patients, and other modalities, such as upper gastrointestinal contrast study, should be used to assess for presence of hiatal hernias.2 Addressing these 2 important issues is of paramount importance in future studies. Declaration of Conflicting Interests
对于编辑，我怀着极大的兴趣阅读了1在杂志上发表的文章《the American Foregut Society白皮书on内镜下食管胃结完整性分类》。新提出的美国前肠学会(AFS)分类对抗反流屏障(ARB)完整性进行分级，提供了更全面的评估，与临床医生在日常实践中相关。作者适当地呼吁进一步验证这一新的分类及其与胃食管反流疾病的存在和严重程度的相关性，并进一步扩展分类以评估先前进行过抗反流干预的个体的ARB完整性，1无论是手术还是内镜。然而，未来的方向缺乏解决两个重要的变量，这两个变量可能会影响应用AFS分类对ARB完整性的评估。首先，该分类没有考虑到ARB的麻醉效果。与不使用麻痹剂的清醒镇静相比，使用麻痹剂的全身麻醉下，裂孔孔径往往更大。其次，新的AFS分类也没有考虑肥胖。腹腔镜检查时，在膈裂孔中经常看到一个大的脂肪垫，这可能会妨碍对隐藏裂孔疝的准确判断，无论是内窥镜还是腹腔镜检查。因此，在评估肥胖患者的裂孔疝时需要谨慎，并应采用其他方式，如上胃肠造影研究，来评估裂孔疝的存在在未来的研究中，解决这两个重要问题至关重要。利益冲突声明
{"title":"The Esophagogastric Junction Integrity","authors":"Salih Samo","doi":"10.1177/26345161231170426","DOIUrl":"https://doi.org/10.1177/26345161231170426","url":null,"abstract":"To the editor, I read with great interest the article “The American Foregut Society white paper on the endoscopic classification of esophagogastric junction integrity”1 published in the journal. The newly proposed American Foregut Society (AFS) classification to grade the antireflux barrier (ARB) integrity provides more comprehensive evaluation that are relevant to the practicing clinicians in day-to-day practice. The authors appropriately call for future validation of this novel classification and its correlation with the presence and severity of gastroesophageal reflux disease, and additionally to extend the classification to assess the ARB integrity in individuals with prior antireflux interventions,1 whether surgical or endoscopic. However, the future directions fall short of addressing 2 important variables that may affect the assessment of ARB integrity by applying the AFS classification. First, the classification does not take into consideration the anesthesia effect on the ARB. The hiatal aperture tends to be larger under general anesthesia with use of paralytics as compared to conscious sedation without the use of paralytics. Second, the novel AFS classification does not take obesity into consideration either. It is common to see a large fat pad in the diaphragmatic hiatus during laparoscopy, which may prevent accurate appreciation of a hidden hiatal hernia, whether endoscopically or laparoscopically. Therefore, caution needs to be taken when evaluating for hiatal hernia in obese patients, and other modalities, such as upper gastrointestinal contrast study, should be used to assess for presence of hiatal hernias.2 Addressing these 2 important issues is of paramount importance in future studies. Declaration of Conflicting Interests","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"29 1","pages":"235 - 235"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75540682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1177/26345161231166136
Daniel Scheese, Mohamad Chehab, C. A. Puig
Gastroesophageal reflux disease (GERD) is the most commonly diagnosed digestive disorder in the United States. Higher rates of non-erosive reflux disease (NERD) are found in females while higher rates of erosive reflux disease (ERD) are found in males. Pre-menopausal females appear to be protected from esophageal mucosal damage, as they demonstrate lower rates of ERD, Barrett’s esophagus, and esophageal adenocarcinoma. A protective effect of estrogen on the esophageal mucosa is thought to contribute to this decreased prevalence. A better understanding of sex-related differences in GERD may help alleviate the reported differences in outcomes between sexes regarding medical and surgical management.
{"title":"Sex Differences in Gastroesophageal Reflux Disease (GERD)","authors":"Daniel Scheese, Mohamad Chehab, C. A. Puig","doi":"10.1177/26345161231166136","DOIUrl":"https://doi.org/10.1177/26345161231166136","url":null,"abstract":"Gastroesophageal reflux disease (GERD) is the most commonly diagnosed digestive disorder in the United States. Higher rates of non-erosive reflux disease (NERD) are found in females while higher rates of erosive reflux disease (ERD) are found in males. Pre-menopausal females appear to be protected from esophageal mucosal damage, as they demonstrate lower rates of ERD, Barrett’s esophagus, and esophageal adenocarcinoma. A protective effect of estrogen on the esophageal mucosa is thought to contribute to this decreased prevalence. A better understanding of sex-related differences in GERD may help alleviate the reported differences in outcomes between sexes regarding medical and surgical management.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"3 1","pages":"192 - 198"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66050352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1177/26345161231170423
N. Nguyen, K. Chang, M. Canto, J. Lipham, R. Bell, P. Kahrilas
We thank the reader for their letter and interest in the American Foregut Society (AFS) endoscopic classification of esophagogastric junction (EGJ) integrity.1,2 The reader raised 2 issues regarding potential limitations of our approach. First, it does not consider the effect of anesthesia and the reader commented on the observation that the hiatal aperture tends to enlarge under general anesthesia with the use of paralytics as compared to conscious sedation endoscopy. While this observation is interesting, we are not advocating doing routine upper endoscopy under general anesthesia. It is also worth noting that we were more driven by endoscopic undergrading of hiatal integrity due to insufficient gastric insufflation rather than overgrading, even going so far as to advocate eliciting a hernia with a provocative endoscopic maneuver. The second observation from the reader is that obese patients commonly have a large fat pad at the level of the hiatus that may preclude an accurate depiction of the hiatal defect. We agree that this can lead to “undergrading” the EGJ and should be kept in mind with obese patients. It also emphasizes the need to utilize maximal insufflation of the stomach and provocative maneuvers to elicit a sliding hiatal hernia. However even if the fat pad leads to an underestimation of the hiatus grade, it would not obscure an AFS grade II which is a key difference between AFS grading and the Hill classification. An AFS grade II is considered pathologic, representing partial hiatus disruption with loss of the intraabdominal esophageal length along with the gastroesophageal flap valve and the angle of His. In contrast, a Hill grade II is considered to be a normal finding. We thank the reader for their interest and astute comments. Declaration of Conflicting Interests
{"title":"Reply to the Esophagogastric Junction Integrity","authors":"N. Nguyen, K. Chang, M. Canto, J. Lipham, R. Bell, P. Kahrilas","doi":"10.1177/26345161231170423","DOIUrl":"https://doi.org/10.1177/26345161231170423","url":null,"abstract":"We thank the reader for their letter and interest in the American Foregut Society (AFS) endoscopic classification of esophagogastric junction (EGJ) integrity.1,2 The reader raised 2 issues regarding potential limitations of our approach. First, it does not consider the effect of anesthesia and the reader commented on the observation that the hiatal aperture tends to enlarge under general anesthesia with the use of paralytics as compared to conscious sedation endoscopy. While this observation is interesting, we are not advocating doing routine upper endoscopy under general anesthesia. It is also worth noting that we were more driven by endoscopic undergrading of hiatal integrity due to insufficient gastric insufflation rather than overgrading, even going so far as to advocate eliciting a hernia with a provocative endoscopic maneuver. The second observation from the reader is that obese patients commonly have a large fat pad at the level of the hiatus that may preclude an accurate depiction of the hiatal defect. We agree that this can lead to “undergrading” the EGJ and should be kept in mind with obese patients. It also emphasizes the need to utilize maximal insufflation of the stomach and provocative maneuvers to elicit a sliding hiatal hernia. However even if the fat pad leads to an underestimation of the hiatus grade, it would not obscure an AFS grade II which is a key difference between AFS grading and the Hill classification. An AFS grade II is considered pathologic, representing partial hiatus disruption with loss of the intraabdominal esophageal length along with the gastroesophageal flap valve and the angle of His. In contrast, a Hill grade II is considered to be a normal finding. We thank the reader for their interest and astute comments. Declaration of Conflicting Interests","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"7 1","pages":"236 - 236"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81485456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1177/26345161231191696
F. Jaber, W. Johnson, N. Wilson, Saqr Alsakarneh, Mouhand F. H. Mohamed, K. Ahmed, Nicole Patel, B. Hanson, Mohamed Abdallah, M. Bilal
The endoscopic Functional Lumen Imaging Probe (FLIP) devices are used to evaluate pressure changes, diameter, and volume of the esophagus. We used the FDA’s MAUDE database to collect post-marketing surveillance data on these devices from January 2009 to September 2022. Forty-Five device-related events and thirty-six patient-related adverse events were analyzed. The most common device issue for the diagnostic FLIP device was therapeutic/diagnostic failure (n = 6), while the most frequent issue with the therapeutic FLIP device was adverse events without an identified device or use problem (n = 11). Patient-related adverse events were extremely rare with the diagnostic FLIP and the most common patient-related adverse event with the therapeutic FLIP was perforation (n = 11). Endoscopists need to be mindful of these potential technical issues and adverse events while using these devices.
{"title":"Analysis of Reported Adverse Events Associated With the Use of Functional Lumen Imaging Probe Devices in the Esophagus and Stomach: An FDA MAUDE Database Study","authors":"F. Jaber, W. Johnson, N. Wilson, Saqr Alsakarneh, Mouhand F. H. Mohamed, K. Ahmed, Nicole Patel, B. Hanson, Mohamed Abdallah, M. Bilal","doi":"10.1177/26345161231191696","DOIUrl":"https://doi.org/10.1177/26345161231191696","url":null,"abstract":"The endoscopic Functional Lumen Imaging Probe (FLIP) devices are used to evaluate pressure changes, diameter, and volume of the esophagus. We used the FDA’s MAUDE database to collect post-marketing surveillance data on these devices from January 2009 to September 2022. Forty-Five device-related events and thirty-six patient-related adverse events were analyzed. The most common device issue for the diagnostic FLIP device was therapeutic/diagnostic failure (n = 6), while the most frequent issue with the therapeutic FLIP device was adverse events without an identified device or use problem (n = 11). Patient-related adverse events were extremely rare with the diagnostic FLIP and the most common patient-related adverse event with the therapeutic FLIP was perforation (n = 11). Endoscopists need to be mindful of these potential technical issues and adverse events while using these devices.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"3 1","pages":"338 - 343"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66050981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1177/26345161231178351
Avanti Badrinathan, Thomas A. Syphan, A. Bassiri, J. Linden, Christine E. Alvarado, Jillian N. Sinopoli, Leonidas Tapias Vargas, C. Towe
The effect of Affordable Care Act Medicaid expansion on access to minimally invasive esophagectomy (MIE) is unknown. We hypothesize that greater Medicaid coverage resulting from ACA expansion would be associated with improved access to MIE, and performed an analysis of the National Cancer Database, comparing MIE rates in Medicaid expansion states to non-expansion states. MIE was more common in expansion states (30.37%vs 23.88%, P < .001). A multivariable difference-in-differences analysis, however, suggested no effect in MIE rate due to Medicaid expansion. This finding suggests that access to care is more complex than access to insurance. Further study is required to characterize disparities in access to MIE.
平价医疗法案医疗补助扩大对微创食管切除术(MIE)的影响尚不清楚。我们假设ACA扩大所带来的更大的医疗补助覆盖范围将与获得MIE的改善有关，并对国家癌症数据库进行了分析，比较了医疗补助扩大州和未扩大州的MIE率。MIE多见于扩张状态(30.37%vs 23.88%， P < 0.001)。然而，一项多变量差异分析表明，由于医疗补助计划的扩大，MIE率没有影响。这一发现表明，获得医疗服务比获得保险更为复杂。需要进一步研究以确定获得MIE方面的差异。
{"title":"The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis","authors":"Avanti Badrinathan, Thomas A. Syphan, A. Bassiri, J. Linden, Christine E. Alvarado, Jillian N. Sinopoli, Leonidas Tapias Vargas, C. Towe","doi":"10.1177/26345161231178351","DOIUrl":"https://doi.org/10.1177/26345161231178351","url":null,"abstract":"The effect of Affordable Care Act Medicaid expansion on access to minimally invasive esophagectomy (MIE) is unknown. We hypothesize that greater Medicaid coverage resulting from ACA expansion would be associated with improved access to MIE, and performed an analysis of the National Cancer Database, comparing MIE rates in Medicaid expansion states to non-expansion states. MIE was more common in expansion states (30.37%vs 23.88%, P < .001). A multivariable difference-in-differences analysis, however, suggested no effect in MIE rate due to Medicaid expansion. This finding suggests that access to care is more complex than access to insurance. Further study is required to characterize disparities in access to MIE.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"36 1","pages":"199 - 207"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77284863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-30DOI: 10.1177/26345161231178352
Lee L. Swanstöm
Endoscopic pylormyotomy is a new very minimally invasive treatment option for delayed gastric emptying—an increasingly common clinical problem. However, as with any novel procedure, critical decision-making is necessary to ensure optimal patient outcomes. In this article, we discuss the various factors that should be considered when deciding whether to perform G-POEM, including patient selection, pre-operative workup including newer dynamic test modalities, technical considerations, and post-operative management. We also highlight potential complications and their management. By understanding the critical decision-making process involved in G-POEM, physicians can optimize patient outcomes and improve overall success rates of this procedure.
{"title":"Critical Decision Making: Endoscopic Pyloromyotomy","authors":"Lee L. Swanstöm","doi":"10.1177/26345161231178352","DOIUrl":"https://doi.org/10.1177/26345161231178352","url":null,"abstract":"Endoscopic pylormyotomy is a new very minimally invasive treatment option for delayed gastric emptying—an increasingly common clinical problem. However, as with any novel procedure, critical decision-making is necessary to ensure optimal patient outcomes. In this article, we discuss the various factors that should be considered when deciding whether to perform G-POEM, including patient selection, pre-operative workup including newer dynamic test modalities, technical considerations, and post-operative management. We also highlight potential complications and their management. By understanding the critical decision-making process involved in G-POEM, physicians can optimize patient outcomes and improve overall success rates of this procedure.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"3 1","pages":"303 - 306"},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66050489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-27DOI: 10.1177/26345161231173643
D. Armstrong, S. Srinivasan, Ceciel Rooker, P. Sinclair, E. Taylor, Prateek Sharma
Proton pump inhibitors (PPIs) are highly effective in treating gastroesophageal reflux disease (GERD). However, persistent, troublesome reflux symptoms despite PPI use are common, and a proportion of individuals with these persistent symptoms is considered to have refractory GERD (rGERD). There are limited data on patients’ experience with persistent reflux-like symptoms to guide healthcare professionals in managing this troublesome condition. An international, population-based, online survey was conducted among adults who reported persistent reflux-like symptoms; 24 questions were posed regarding the participants’ symptoms, diagnosis, treatment, and comorbid conditions. Descriptive analyses were performed to characterize participants’ experience with diagnosis and their satisfaction with treatment. All data were self-reported. Of 565 initial respondents, 283 (51%) answered the question regarding being formally diagnosed by a healthcare professional with GERD and/or rGERD. The 197 (70%) participants who answered “yes” made up the survey population. Heartburn (65%) and acid regurgitation (62%) were the most common troublesome symptoms. PPI use was reported by 145 (74%) respondents, but only 30% were satisfied with PPI therapy. The most common alternative therapies included antacid/alginates (63%), histamine H2-receptor antagonists (33%), mucosal protectants (25%), and lifestyle modifications (84%). In this population-based survey, nearly one-third of participants with persistent reflux-like symptoms had not received a formal diagnosis of GERD or rGERD. Although most participants diagnosed with GERD/rGERD had received PPI therapy, persistent symptoms, dissatisfaction with PPI therapy, and concerns about long-term PPI use were common. These data emphasize the need for patient input when developing management strategies for GERD and persistent reflux-like symptoms or rGERD.
{"title":"Symptom Profile, Proton Pump Inhibitor Therapy, and Diagnostic Testing in Patients With Persistent Reflux-Like Symptoms: Results From a Population-Based Survey","authors":"D. Armstrong, S. Srinivasan, Ceciel Rooker, P. Sinclair, E. Taylor, Prateek Sharma","doi":"10.1177/26345161231173643","DOIUrl":"https://doi.org/10.1177/26345161231173643","url":null,"abstract":"Proton pump inhibitors (PPIs) are highly effective in treating gastroesophageal reflux disease (GERD). However, persistent, troublesome reflux symptoms despite PPI use are common, and a proportion of individuals with these persistent symptoms is considered to have refractory GERD (rGERD). There are limited data on patients’ experience with persistent reflux-like symptoms to guide healthcare professionals in managing this troublesome condition. An international, population-based, online survey was conducted among adults who reported persistent reflux-like symptoms; 24 questions were posed regarding the participants’ symptoms, diagnosis, treatment, and comorbid conditions. Descriptive analyses were performed to characterize participants’ experience with diagnosis and their satisfaction with treatment. All data were self-reported. Of 565 initial respondents, 283 (51%) answered the question regarding being formally diagnosed by a healthcare professional with GERD and/or rGERD. The 197 (70%) participants who answered “yes” made up the survey population. Heartburn (65%) and acid regurgitation (62%) were the most common troublesome symptoms. PPI use was reported by 145 (74%) respondents, but only 30% were satisfied with PPI therapy. The most common alternative therapies included antacid/alginates (63%), histamine H2-receptor antagonists (33%), mucosal protectants (25%), and lifestyle modifications (84%). In this population-based survey, nearly one-third of participants with persistent reflux-like symptoms had not received a formal diagnosis of GERD or rGERD. Although most participants diagnosed with GERD/rGERD had received PPI therapy, persistent symptoms, dissatisfaction with PPI therapy, and concerns about long-term PPI use were common. These data emphasize the need for patient input when developing management strategies for GERD and persistent reflux-like symptoms or rGERD.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43728981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-19DOI: 10.1177/26345161231174246
C. Dunn, Sven E. Eriksson, B. Jobe, S. Ayazi
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.
{"title":"Endoscopy and Antireflux Surgery: A Technical Review of Pre- and Postoperative Evaluation and Recognizing Patterns of Failure","authors":"C. Dunn, Sven E. Eriksson, B. Jobe, S. Ayazi","doi":"10.1177/26345161231174246","DOIUrl":"https://doi.org/10.1177/26345161231174246","url":null,"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.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42887781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-18DOI: 10.1177/26345161231171379
A. Addo, Kevin Connors, A. Park
The aim of this review is to highlight the racial and ethnic differences in the prevalence, presentation, management, and outcomes of benign foregut disorders. Gastroesophageal reflux disease and achalasia make up the most common benign esophageal disorders. There are limited data in the literature regarding racial and ethnic disparities in the care and management of these disorders. However, studies have shown that racial and ethnic disparities play a role in the management of these disorders. To minimize the impact of these disparities, more effort is needed in identifying the interplay between race, insurance status, socioeconomic status and their underlying mechanism.
{"title":"Benign Esophageal Disorders: The Thing About Race and Ethnicity","authors":"A. Addo, Kevin Connors, A. Park","doi":"10.1177/26345161231171379","DOIUrl":"https://doi.org/10.1177/26345161231171379","url":null,"abstract":"The aim of this review is to highlight the racial and ethnic differences in the prevalence, presentation, management, and outcomes of benign foregut disorders. Gastroesophageal reflux disease and achalasia make up the most common benign esophageal disorders. There are limited data in the literature regarding racial and ethnic disparities in the care and management of these disorders. However, studies have shown that racial and ethnic disparities play a role in the management of these disorders. To minimize the impact of these disparities, more effort is needed in identifying the interplay between race, insurance status, socioeconomic status and their underlying mechanism.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"19 1","pages":"183 - 186"},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82358642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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