Department of Medicine, Duke University, Durham, NC, USA.
Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
Dis Esophagus. 2022 May 10;35(5). doi: 10.1093/dote/doab078.
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.
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.
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.
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.
抗反流手术后（如胃底折叠术），食管有症状的患者常需行上消化道内镜检查（EGD）。内镜评估胃底折叠术的包裹完整性可能具有挑战性。本初步研究的主要目的是评估胃肠病学（GI）住院医师、亚专科医师和前肠外科医师评估尼森胃底折叠术完整性和食管裂孔疝的准确性和信心。
在 20 组 EGD 图像的调查中纳入了尼森胃底折叠术后的五种解剖结构变化，由 GI 住院医师、普通 GI 主治医生、食管科医生和前肠外科医生完成。评估了准确性、诊断信心和提供者之间的组内一致性。
最终队列中有 31 名受访者。提供者类型对术前诊断的信心有显著差异（平均信心为 5 分，GI 住院医师为 1.8 分，普通 GI 主治医生为 2.7 分，食管科医生为 3.6 分，前肠外科医生为 3.6 分，P=0.01）。总体准确性的平均值为 45.9%，按提供者类型有显著差异，GI 住院医师的最低（37%），食管科医生的最高（53%；P=0.01）。在所有包裹完整性变化中，食管科医生的准确性最高。在包裹完整性变化中，组内一致性较低（Krippendorff 的 alpha <0.30），表明提供者之间的协议很少或没有。
在这项多中心调查研究中，GI 住院医师在评估尼森胃底折叠术后的 EGD 图像时准确性和信心最低，而食管科医生则最高。诊断信心差异很大，组内一致性差。这些发现表明经验可能会提高信心，但突出了需要改进对胃底折叠术包裹的评估。
