Radiographic Predictability of Hiatal Hernia Prior to Gastric Band Surgery

Broucek, Joseph; Ritter, L; Francescatti, Amanda B.; Smith, Claire; Luu, Minh B.; Autajay, Khristi; Myers, Jonathan A.

doi:10.4293/108680813x13753907291233

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Furthermore, the finding during the operation still has the most accurate evidence. In the study of Broucek JR, et al [16] showed that UGI series have poor positive and negative predictive values in preoperatively diagnosing HH. Also, patient symptoms were different subjectively and anti-reflux medication did not match with radiologic or intraoperative findings of HH [17].…”

Section: Methodsmentioning

confidence: 99%

Can Pre-Operative Endoscopy Identify Patients at Risk for Gastroesophageal Reflux Disease after Sleeve Gastrectomy?

R¹,

Khaitan²,

J³

et al. 2018

J Clin Gastroenterol Treat

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Background: Obese individuals have higher incidence of hiatal hernia (HH). There is controversy over the need for preoperative esophagogastroduodenoscopy (EGD) before bariatric procedures. The aim of this study is to determine the predictive value of preoperative endoscopy in diagnosing HH. Methods: Under IRB Approval A retrospective review of 402 cases who underwent sleeve gastrectomy (SG) in our academic center between January 2011 and December 2015 was performed. Patients who had preoperative EGD reports were enrolled in the study. Data were collected for the demographics, preoperative endoscopic and intraoperative findings. Each patient's EGD findings were compared with the intraoperative findings. Results: From total of 402 SG cases, 381 (81% female) had preoperative EGD. The mean age of the subjects was 45.8 years (± 10.6 years) with the mean BMI of 47.5 kg/m 2 (± 8.8 kg/m 2). There was no significant difference in age and BMI between males and females. 80 cases (20.5%) had a preoperative EGD that showed HH and 39 of those (48.7%) had intraoperative findings consistent with HH. 301 (79%) patients had no HH on preoperative EGD, out of which 286 (95%) patients were also negative for HH intraoperatively. Compared with intraoperative diagnosis, EGD had sensitivity of 67% and specificity of 85%. The negative predictive value of EGD was 96% for HH but the positive predictive value was 34%. Conclusions: EGD is a valuable informative tool in preoperative evaluation of bariatric patients. Our study demonstrated that EGD has high negative predictive value in ruling out HH but also with relatively low positive predictive value to prove its presence. Further studies are warranted to evaluate the discrepancies between the preoperative and intraoperative identification of HH, and standardization of definition for theses finding.

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Section: Methodsmentioning

confidence: 99%

Can Pre-Operative Endoscopy Identify Patients at Risk for Gastroesophageal Reflux Disease after Sleeve Gastrectomy?

R¹,

Khaitan²,

J³

et al. 2018

J Clin Gastroenterol Treat

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“…Распространенность данного заболевания среди взрослого населения планеты составляет 21-47%, в пожилом возрасте может достигать 50% [8][9]. С развитием рентгенологической техники и появлением компьютерной томографии стало возможным не только точно диагностировать ГПОД, но и измерять дефект пищеводного отверстия диафрагмы (далее -ПОД), расстояние между диафрагмальными ножками в разных проекциях и состояние диафрагмы [10][11][12][13][14]. В публикациях ряда авторов имеются данные о прижизненной компьютерно-томографической анатомии кардиоэзофагеального перехода в норме и при гастроэзофагеальной рефлюксной болезни, при этом нет детальных морфометрических параметров структур кардиоэзофагеального перехода при ГПОД [15][16].…”

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The Lifetime Morphometry of Cardioesophageal Transition in Patients With Hiatal Hernia

et al. 2022

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With the development of X-ray technology and the advent of computed tomography, it became possible not only to accurately diagnose hiatal hernia, but also to conduct morphometry of all its constituent anatomical structures in different projections to use the data obtained at the stage of preoperative planning for its surgical treatment. Currently, due to the improvement in the quality of diagnostics, there is an increase in the detection of patients with this pathology, along with this, the question of choosing the most rational method of treatment is acute. The aim of the study was to study the computed tomographic anatomy of the structures of the cardioesophageal junction in patients with hiatal hernia. A retrospective study of a series of computed tomograms in 53 patients with hiatal hernia, performed on a 64-slice Canon Aquilion Prime tomograph, was carried out. An assessment was made of the diameter of the distal esophagus, the size of the hernia orifice, and the deviation of the axis of the esophagus at the level of the hernial orifice relative to the diaphragm in two planes. As a result of the analysis, it was found that in 79% of cases the esophagus was located on the right and behind the hernial sac, in 13% - behind and in the middle, in 8% - on the left and behind. It was revealed that the diameter of the unchanged part of the esophagus above the hernial sac was 20.9±3.71 mm (min – 15.7 mm, max – 30.2 mm). The dimensions of the hernial orifice varied within 31.21±5.23 mm in the frontal plane (min - 24.7 mm, max - 42 mm) and 32.66±4.36 mm in the sagittal plane (min - 26.2 mm, max - 39.1 mm). The deviation of the axis of the esophagus in the frontal plane was 63.53°±16.74 (min - 19.6°, max - 92.3°). The deviation of the axis of the esophagus in the sagittal plane was 74.12°±21.31 (min - 36.3°, max - 118.1°). Thus, due to the variability in the structure and location of the anatomical structures of the cardioesophageal zone in patients with hiatal hernia, it is necessary to take into account all of the above indicators, including the presence or absence of large branches of the greater omentum in the hernial sac, body type, gender, age of patients, which serves an integral part of preoperative planning of surgical treatment, optimization and reduction of complications, as well as determining the safest method of its surgery.

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Diagnostic value of X‐ray, endoscopy, and high‐resolution manometry for hiatal hernia: A systematic review and meta‐analysis

Gao

Zhang

et al. 2019

J of Gastro and Hepatol

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Background and AimHiatal hernia (HH) has been found in a large number of people, but there has been no unified way to diagnose it. The aim of this study was to compare the diagnostic efficiency of X‐ray, endoscopy, and high‐resolution manometry (HRM) in the diagnosis of HH using surgical diagnosis of HH as the gold standard.MethodsTwo biomedical databases (PubMed and EMBASE) were systematically searched through January 26, 2019. The pooled sensitivity, specificity, and area under the SROC curve (AUC) were calculated, and the AUC statistical significance was compared by Tukey's multiple comparisons test.ResultsA total of 5337 patients in seven articles were included. The pooled sensitivity, specificity, and AUC for X‐ray were 0.63 (0.46–0.77), 0.85 (0.69–0.94), and 0.80 (0.77–0.84), respectively, for diagnosing HH. The pooled estimates for endoscopy in diagnosing HH were as follows: sensitivity, 0.72 (0.39–0.91); specificity, 0.80 (0.70–0.87); and AUC, 0.82 (0.78–0.85). Similarly, the corresponding values for HRM were 0.77 (0.70–0.83); 0.92 (0.85–0.96), and 0.9527. Tukey's multiple comparisons tests were used to compare the AUCs of the three diagnostic methods: No significant differences were found between X‐ray and endoscopy (P = 0.7293), and HRM was superior to X‐ray (P = 0.0127) and endoscopy (P = 0.0442).ConclusionsHigh‐resolution manometry may exhibit a better diagnostic performance for hiatal hernia. In contrast, X‐ray and endoscopy may not be the best methods, and there was no significant difference in diagnostic efficiency between the X‐ray and endoscopy.

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Radiographic Predictability of Hiatal Hernia Prior to Gastric Band Surgery

Cited by 3 publications

References 10 publications

Can Pre-Operative Endoscopy Identify Patients at Risk for Gastroesophageal Reflux Disease after Sleeve Gastrectomy?

Can Pre-Operative Endoscopy Identify Patients at Risk for Gastroesophageal Reflux Disease after Sleeve Gastrectomy?

The Lifetime Morphometry of Cardioesophageal Transition in Patients With Hiatal Hernia

Diagnostic value of X‐ray, endoscopy, and high‐resolution manometry for hiatal hernia: A systematic review and meta‐analysis

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