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Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation.

Publication ,  Journal Article
Song, EJ; Yadlapati, R; Chen, JW; Parish, A; Whitson, MJ; Ravi, K; Patel, A; Carlson, DA; Khan, A; Niedzwiecki, D; Leiman, DA
Published in: Dis Esophagus
May 10, 2022

BACKGROUND: Upper endoscopy (EGD) is frequently performed in patients with esophageal complaints following anti-reflux surgery such as fundoplication. Endoscopic evaluation of fundoplication wrap integrity can be challenging. Our primary aim in this pilot study was to evaluate the accuracy and confidence of assessing Nissen fundoplication integrity and hiatus herniation among gastroenterology (GI) fellows, subspecialists, and foregut surgeons. METHODS: Five variations of post-Nissen fundoplication anatomy were included in a survey of 20 sets of EGD images that was completed by GI fellows, general GI attendings, esophagologists, and foregut surgeons. Accuracy, diagnostic confidence, and inter-rater agreement across providers were evaluated. RESULTS: There were 31 respondents in the final cohort. Confidence in pre-survey diagnostics significantly differed by provider type (mean confidence out of 5 was 1.8 for GI fellows, 2.7 for general GI attendings, 3.6 for esophagologists, and 3.6 for foregut surgeons, P = 0.01). The mean overall accuracy was 45.9%, which significantly differed by provider type with the lowest rate among GI fellows (37%) and highest among esophagologists (53%; P = 0.01). The accuracy was highest among esophagologists across all wrap integrity variations. Inter-rater agreement was low across wrap integrity variations (Krippendorf's alpha <0.30), indicating low to no agreement between providers. CONCLUSION: In this multi-center survey study, GI fellows had the lowest accuracy and confidence in assessing EGD images after Nissen fundoplication, whereas esophagologists had the highest. Diagnostic confidence varied considerably and inter-rater agreement was poor. These findings suggest experience may improve confidence, but highlight the need to improve the evaluation of fundoplication wraps.

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Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

May 10, 2022

Volume

35

Issue

5

Location

United States

Related Subject Headings

  • Pilot Projects
  • Laparoscopy
  • Humans
  • Gastroscopy
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Fundoplication
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Song, E. J., Yadlapati, R., Chen, J. W., Parish, A., Whitson, M. J., Ravi, K., … Leiman, D. A. (2022). Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation. Dis Esophagus, 35(5). https://doi.org/10.1093/dote/doab078
Song, Erin J., Rena Yadlapati, Joan W. Chen, Alice Parish, Matthew J. Whitson, Karthik Ravi, Amit Patel, et al. “Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation.Dis Esophagus 35, no. 5 (May 10, 2022). https://doi.org/10.1093/dote/doab078.
Song EJ, Yadlapati R, Chen JW, Parish A, Whitson MJ, Ravi K, et al. Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation. Dis Esophagus. 2022 May 10;35(5).
Song, Erin J., et al. “Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation.Dis Esophagus, vol. 35, no. 5, May 2022. Pubmed, doi:10.1093/dote/doab078.
Song EJ, Yadlapati R, Chen JW, Parish A, Whitson MJ, Ravi K, Patel A, Carlson DA, Khan A, Niedzwiecki D, Leiman DA. Variability in endoscopic assessment of Nissen fundoplication wrap integrity and hiatus herniation. Dis Esophagus. 2022 May 10;35(5).
Journal cover image

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

May 10, 2022

Volume

35

Issue

5

Location

United States

Related Subject Headings

  • Pilot Projects
  • Laparoscopy
  • Humans
  • Gastroscopy
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Fundoplication
  • 3202 Clinical sciences
  • 1103 Clinical Sciences