Original ArticleEUS characteristics of Nissen fundoplication: normal appearance and mechanisms of failure
Section snippets
EUS of the native esophagogastric junction
Two swine, managed under the regulations of the Animal Care and Use Committee of the Oregon Health and Science University, underwent a 2-week acclimation period. Animals were fasted for 12 hours before the operation, and endotracheal anesthesia was maintained with 2.5% isoflurane and oxygen. At the conclusion of the procedures, the animals were euthanized with Euthasol, 1 mL per 4.5 kg.
Upper endoscopy with a 9.8-mm GIF140 endoscope (Olympus America Corp, Melville, NY) and EUS with a 7.5-MHz
Results
EUS images were interpreted in the context of the intrinsic and extrinsic anatomic relationships at the esophagogastric junction (Fig. 1). As the esophagus passes from the thoracic cavity to the abdominal cavity, it travels through the hiatus, which is created by the right and left bundles of the right crus and the anterior fusion of their muscle bundles. The hiatus is located to the left of midline, close to the posterior border of the central tendon of the diaphragm. From the level of the
Discussion
This pilot study has explored the use of EUS as a modality to image esophagogastric junction anatomy in the native state and after antireflux surgery. Our data demonstrate that EUS of hiatal anatomic relationships is feasible and provides useful information regarding the integrity of Nissen fundoplication and its relationship to the diaphragm.
The incidence of the various mechanisms of antireflux surgery failure vary significantly between studies (slipped, 3%-30%; dehiscence, 15%-30%;
Acknowledgments
We would like to thank Kevin Reavis, MD, and John Davis, MD, for their assistance with this study.
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Presented, in part, as an oral presentation at the 14th World Congress of the International Association of Surgeons and Gastroenterologists, September 8-11, 2004, Zurich, Switzerland.
This work was supported, in part, by National Institutes of Health grants K23 DK066165-01 (B.A.J.), RO3 CA105959-01 (B.A.J.), RO1 DC00646 (P.J.K.), and the Society of American Gastrointestinal and Endoscopic Surgeons (B.A.J.).