Endoscopic diagnosis of slicling-type diaphragmatic hiatal hernias

Summary

The accuracy of the different esophagoscopic and gastroscopic technics for the diagnosis of hiatal hernia has been evaluated in 200 patients. Intragastric and intraesophageal pressures during endoscopic examination and Valsalva maneuver and studies to localize the diaphragmatic hiatus and to determine the presence of gastroesophageal reflux were performed on some of the patients.

The observations suggest that the endoscopist is able to visualize adequately and localize the impression made by the diaphragmatic hiatus on the gut lumen by employing the LoPresti fiber optic esophagoscope, the Eder-Palmer gastroscope and the Hirschowitz Fiberscope. The accuracy of each endoscope in detecting a sliding-type hiatal hernia was as follows: Eder-Hufford esophagoscope, 27%; LoPresti fiber optic esophagoscope, 97%; Eder-Palmer gastroscope, 97%; and Hirschowitz Fiberscope.

The LoPresti fiber optic esophagoscope and the Eder-Palmer gastroscope appear to be the best instruments for examination of the esophagogastric junctional area and for detection of a sliding-type hiatal hernia.

Gastroscopy not only permits visualization of a hernia pouch but air insufflation appears to aid in its demonstration. Our observations suggest that the small endoscopically detected sliding-type hiatal hernias in symptomatic patients are of clinical significance, and may represent the etiology of obscure pain which at present cannot be accurately diagnosed by any other method.