To assess the diagnostic potential of dynamic real-time MRI for fundoplication failure in patients with persistent or recurrent GERD-like (gastroesophageal reflux disease) complaints.
Material and methods
Twenty-two consecutive patients (male n = 11; female n = 11; median age 59 years) with recurrent or persistent GERD-like symptom after fundoplication were enrolled between 2015 and 2017. Median duration of GERD-like symptoms was 21 months. Real-time MRI (3 Tesla) was performed at 40 ms temporal resolution using undersampled radial fast low-angle shot acquisitions with nonlinear inverse image reconstruction. MRI movies dynamically visualized bolus transit of pineapple juice through the gastroesophageal junction, position of the fundoplication wrap and recurring hernia or reflux during Valsalva maneuver. MRI results were compared to endoscopic findings.
Real-time MRI was successfully completed in all patients without adverse events (average examination time 15 min). Morphological correlates for GERD-like symptoms were evident in 20 patients (90.1%) with gastric reflux in 19 cases. Nine patients (40.1%) had wrap disruption and recurrent gastric hernia. Wrap migration or telescoping hernia was detected in nine patients (40.1%). One patient presented with continued reflux despite intact fundoplication wrap. Esophageal dysmotility with delayed bolus passage was observed in one case. On endoscopy, gastric hernia or wrap disruption was diagnosed in seven cases, and esophagitis or Barret’s metaplasia in nine cases.
Real-time MRI is a fast and safe modality for dynamic imaging after fundoplication, without radiation exposure or administration of gadolinium-based contrast media. In a relevant number of cases, real-time MRI reveals correlates for GERD-like symptoms.
• Real-time MRI reliably visualizes the gastroesophageal junction after fundoplication surgery.
• Patients with recurring GERD-like symptoms have a high rate of morphological failure patterns that can be identified by real-time MRI.
• Dynamic assessment of gastroesophageal junction by real-time MRI is a perspective diagnostic tool for detection of fundoplication failure.
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Gastroesophageal reflux disease
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The authors state that this work has not received any funding.
The scientific guarantor of this publication is Ali Seif Amir Hosseini.
Conflict of interest
Jens Frahm and Martin Uecker are co-inventors of a patent covering the real-time MRI technique used in this study.
Statistics and biometry
Statistical analyses were performed by a co-author with MPH degree.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• descriptive diagnostic study
• performed at one institution
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Seif Amir Hosseini, A., Uhlig, J., Streit, U. et al. Real-time MRI for the dynamic assessment of fundoplication failure in patients with gastroesophageal reflux disease. Eur Radiol 29, 4691–4698 (2019). https://doi.org/10.1007/s00330-019-06025-x
- Magnetic resonance imaging
- Gastroesophageal reflux disease (GERD)