- Design
- Single-centre development and prospective validation cohort
- Population
- 122 adults after antireflux surgery
- Primary outcome
- Pathological reflux by Lyon 2.0 criteria
- Effect
- AUC 0.870 in validation; reflux 11.8% to 85.7% with 0 to 3 signs
A single-centre study built and then prospectively validated a simple endoscopic grading of fundoplication integrity in 122 patients who had endoscopy, manometry and reflux monitoring after antireflux surgery.
Three findings on retroflexed view were linked to objectively confirmed reflux: an intrathoracic valve, a disrupted valve and a visible hiatus. Pathological reflux rose from 11.8% to 37.5% to 85.7% as more of these were present. The grading discriminated reflux with an AUC of 0.87 in the validation group.
It offers a structured way to report post-fundoplication endoscopy. It needs testing in other centres before it guides revision decisions on its own.
- Record valve position, valve integrity and hiatal opening on every post-fundoplication endoscopy
- Request reflux monitoring when two or more of these signs are present with symptoms
- Use retroflexed video where possible so findings can be reviewed
- Do not decide on revision from endoscopy alone without functional testing
Why it matters
Post-fundoplication endoscopy is often reported loosely, and a simple shared grading makes failure easier to recognise.
The statistics, in plain English
An AUC of 0.87 means the grading ranks a patient with reflux above one without about 87% of the time — good, but from a small single-centre sample.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free