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European Radiology

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01-09-2014 | Gastrointestinal

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

Authors: Christiane Kulinna-Cosentini, Wolfgang Schima, Ahmed Ba-Ssalamah, Enrico P. Cosentini

Published in: European Radiology | Issue 9/2014

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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Title: MRI patterns of Nissen fundoplication: normal appearance and mechanisms of failure
Authors: Christiane Kulinna-Cosentini
Wolfgang Schima
Ahmed Ba-Ssalamah
Enrico P. Cosentini
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3267-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Key points

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Key points

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