Endoscopy Can Flag Failed Fundoplication Before Symptoms Return

A simple endoscopic classification, based on valve position, valve disruption, and hiatal opening, identified pathologic reflux after antireflux surgery in 122 patients across development and validation cohorts.

• Pathologic reflux rose from 11.8% to 37.5% to 85.7% as impaired mechanisms increased from none to two or more.
• The classification discriminated pathologic reflux with an area under the curve of 0.87 in the validation cohort.

This is a single-center study, so it supports using the endoscopic grading as a screening aid after fundoplication, not as a replacement for manometry and reflux monitoring when the decision to re-operate is at stake.