Barium Studies Show Complications of Reflux Surgery

All patients had a barium study, wherein the patient drank barium and then had a series of x-rays. Following this, all had an endoscopy or a second surgery.

Laparoscopic fundoplication entails having part of the stomach wrapped around the distal esophagus to prevent the reflux from going into the esophagus. The x-rays showed that 41 of the patients had radiographic signs of unwrapping, while 12 were normal. Twenty-two patients had abnormal collections of contrast media noted on their x-rays. If the x-ray showed that the barium had collected above the diaphragm, it was a strong indication that the surgically created wrap had come unwrapped. The barium studies were less reliable if there was abnormal contrast media collection below the diaphragm. Eighteen of the 22 patients were confirmed by endoscopy or surgery to have defects in their fundoplication.

In addition, some patients had signs of hernias on their x-rays. Upper gastrointestinal barium studies detected 16 hernias, including three that were missed by endoscopy. On the other hand, endoscopy detected 10 hernias, including one not seen on the x-rays. One hernia was missed by both the barium study and endoscopy. The second surgery confirmed that 18 patients were suffering from hernias.

"Because of the large increase in this type of surgery and because the rate of complications, it is essential that radiologists be aware of what to look for in these patients,” said Frank Miller, M.D., chief of body imaging at Northwestern University in Chicago (IL, USA) and one of the study's authors. "Barium studies cost less and are easier on the patient.”




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