EUS characteristics of Nissen fundoplication: Normal appearance and mechanisms of failure

Deepak V. Gopal, Eugene Y. Chang, Charles Y. Kim, Corinne Sandone, Patrick R. Pfau, Terrence J. Frick, John Hunter, Peter J. Kahrilas, Blair A. Jobe

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: In patients who develop symptoms after Nissen fundoplication, the precise mechanism of failure can be difficult to determine. Current testing modalities do not demonstrate sufficient anatomic detail to definitively determine the mechanism. This observational study establishes that EUS can determine fundoplication integrity and hiatal anatomic relationships after Nissen fundoplication. Methods: EUS was performed on the native esophagogastric junction and after Nissen fundoplication in two swine. The EUS characteristics of a properly performed fundoplication were determined. Subsequently, complications of Nissen fundoplication were created, and EUS was performed on each. The EUS criteria of each mechanism of failure were defined. Results: EUS provided sufficient axial resolution to distinguish the esophagus, the fundoplication, and the surrounding hiatal structures within a single image. US of the native esophagogastric junction discerned the length of intra-abdominal esophagus, esophagogastric junction, crura, and anterior hiatus, and, thus, the point of entry into the abdominal cavity. EUS of Nissen fundoplication revealed a 5-layered pattern in a 360° configuration. These layers represent the following: (1) the esophageal wall, (2) the space between the esophagus and the fundoplication, (3) the inner gastric wall of the fundoplication, (4) the gastric lumen, and (5) the outer gastric wall of the fundoplication. A slipped repair was identified by the presence of an echogenic gastric serosa within the fundoplication. A tight fundoplication results in attenuation of the gastric walls, thickening of the esophageal wall, and loss of the 5-layer pattern secondary to obliteration of the potential spaces of the gastric lumen. Dehiscence of the fundoplication was evidenced by a less than 360°5-layer pattern. Conclusions: EUS of hiatal anatomic relationships is feasible and provides detailed information regarding the integrity and the position of a Nissen fundoplication. EUS may enable a precise determination of the anatomic causes of failure after antireflux surgery.

Original languageEnglish (US)
Pages (from-to)35-44
Number of pages10
JournalGastrointestinal Endoscopy
Volume63
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

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Fundoplication
Stomach
Esophagogastric Junction
Esophagus
Serous Membrane
Abdominal Cavity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gopal, D. V., Chang, E. Y., Kim, C. Y., Sandone, C., Pfau, P. R., Frick, T. J., ... Jobe, B. A. (2006). EUS characteristics of Nissen fundoplication: Normal appearance and mechanisms of failure. Gastrointestinal Endoscopy, 63(1), 35-44. https://doi.org/10.1016/j.gie.2005.08.044

EUS characteristics of Nissen fundoplication : Normal appearance and mechanisms of failure. / Gopal, Deepak V.; Chang, Eugene Y.; Kim, Charles Y.; Sandone, Corinne; Pfau, Patrick R.; Frick, Terrence J.; Hunter, John; Kahrilas, Peter J.; Jobe, Blair A.

In: Gastrointestinal Endoscopy, Vol. 63, No. 1, 01.2006, p. 35-44.

Research output: Contribution to journalArticle

Gopal, DV, Chang, EY, Kim, CY, Sandone, C, Pfau, PR, Frick, TJ, Hunter, J, Kahrilas, PJ & Jobe, BA 2006, 'EUS characteristics of Nissen fundoplication: Normal appearance and mechanisms of failure', Gastrointestinal Endoscopy, vol. 63, no. 1, pp. 35-44. https://doi.org/10.1016/j.gie.2005.08.044
Gopal, Deepak V. ; Chang, Eugene Y. ; Kim, Charles Y. ; Sandone, Corinne ; Pfau, Patrick R. ; Frick, Terrence J. ; Hunter, John ; Kahrilas, Peter J. ; Jobe, Blair A. / EUS characteristics of Nissen fundoplication : Normal appearance and mechanisms of failure. In: Gastrointestinal Endoscopy. 2006 ; Vol. 63, No. 1. pp. 35-44.
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T2 - Normal appearance and mechanisms of failure

AU - Gopal, Deepak V.

AU - Chang, Eugene Y.

AU - Kim, Charles Y.

AU - Sandone, Corinne

AU - Pfau, Patrick R.

AU - Frick, Terrence J.

AU - Hunter, John

AU - Kahrilas, Peter J.

AU - Jobe, Blair A.

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N2 - Background: In patients who develop symptoms after Nissen fundoplication, the precise mechanism of failure can be difficult to determine. Current testing modalities do not demonstrate sufficient anatomic detail to definitively determine the mechanism. This observational study establishes that EUS can determine fundoplication integrity and hiatal anatomic relationships after Nissen fundoplication. Methods: EUS was performed on the native esophagogastric junction and after Nissen fundoplication in two swine. The EUS characteristics of a properly performed fundoplication were determined. Subsequently, complications of Nissen fundoplication were created, and EUS was performed on each. The EUS criteria of each mechanism of failure were defined. Results: EUS provided sufficient axial resolution to distinguish the esophagus, the fundoplication, and the surrounding hiatal structures within a single image. US of the native esophagogastric junction discerned the length of intra-abdominal esophagus, esophagogastric junction, crura, and anterior hiatus, and, thus, the point of entry into the abdominal cavity. EUS of Nissen fundoplication revealed a 5-layered pattern in a 360° configuration. These layers represent the following: (1) the esophageal wall, (2) the space between the esophagus and the fundoplication, (3) the inner gastric wall of the fundoplication, (4) the gastric lumen, and (5) the outer gastric wall of the fundoplication. A slipped repair was identified by the presence of an echogenic gastric serosa within the fundoplication. A tight fundoplication results in attenuation of the gastric walls, thickening of the esophageal wall, and loss of the 5-layer pattern secondary to obliteration of the potential spaces of the gastric lumen. Dehiscence of the fundoplication was evidenced by a less than 360°5-layer pattern. Conclusions: EUS of hiatal anatomic relationships is feasible and provides detailed information regarding the integrity and the position of a Nissen fundoplication. EUS may enable a precise determination of the anatomic causes of failure after antireflux surgery.

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