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MRI patterns of Nissen fundoplication: normal appearance and mechanisms of failure

  • Gastrointestinal
  • Published:
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Abstract

Purpose

The purpose of the study was to assess the role of MR fluoroscopy in the evaluation of post-surgical conditions of Nissen fundoplication due to gastro-oesophageal reflux disease (GERD).

Methods

A total of 29 patients (21 patients with recurrent/persistent symptoms and eight asymptomatic patients as the control group) underwent MRI of the oesophagus and gastro-oesophageal junction (GEJ) at 1.5 T. Bolus transit of a buttermilk-spiked gadolinium mixture was evaluated with T2-weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) and dynamic gradient echo sequences (B-FFE) in three planes. The results of MRI were compared with intraoperative findings, or, if the patients were treated conservatively, with endoscopy, manometry, pH-metry and barium swallow.

Results

MRI was able to determine the position of fundoplication wrap in 27/29 cases (93 % overall accuracy) and to correctly identify 4/6 malpositions (67 %), as well as all four wrap disruptions. All five stenoses in the GEJ were identified and could be confirmed intraoperatively or during dilatation. MRI correctly visualized three cases with motility disorders, which were manometrically confirmed as secondary achalasia. Three patients showed signs of recurrent reflux without anatomical failure.

Conclusion

MRI is a promising diagnostic method to evaluate morphologic integrity of Nissen fundoplication and functional disorders after surgery.

Key points

• MRI offers simultaneous morphological and functional imaging in one diagnostic method.

• MR fluoroscopy offers the possibility to identify the wrap position.

• MRI enables a non-invasive diagnosis, providing detailed information for the surgeon.

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Acknowledgements

The scientific guarantor of this publication is Enrico P. Cosentini. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Christiane Kulinna-Cosentini & Ahmed Ba-Ssalamah

  2. Department of Radiology, Krankenhaus Göttlicher Heiland, Krankenhaus der Barmherzigen Schwestern Wien und Sankt Josef Krankenhaus, Vienna, Austria

    Wolfgang Schima

  3. Department of Surgery, Medical University of Vienna, Vienna, Austria

    Enrico P. Cosentini

Authors
  1. Christiane Kulinna-Cosentini
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  2. Wolfgang Schima
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  3. Ahmed Ba-Ssalamah
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  4. Enrico P. Cosentini
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Corresponding author

Correspondence to Christiane Kulinna-Cosentini.

Electronic supplementary material

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This short video in sagittal view shows a normal postoperative appearance after Nissen fundoplication on MRI. Contrast medium passes through the esophagus and the esophagogastric junction through the wrap. The transit time is normal. (MPG 4858 kb)

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Kulinna-Cosentini, C., Schima, W., Ba-Ssalamah, A. et al. MRI patterns of Nissen fundoplication: normal appearance and mechanisms of failure. Eur Radiol 24, 2137–2145 (2014). https://doi.org/10.1007/s00330-014-3267-x

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  • DOI: https://doi.org/10.1007/s00330-014-3267-x

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