Assessment of anti-reflux surgery with endoscopy: a narrative review

Background and Objective: Gastro-esophageal reflux disease (GERD) affects a significant portion of the Australian population. Minimally invasive laparoscopic fundoplication is a highly effective treatment in appropriately selected patients. Endoscopy is an important investigation in the evaluation of pre-operative symptoms, as well as to investigate problems postoperatively. However, endoscopic assessment of postfundoplication anatomy is not standardized and large variations in reporting are seen. The literature was examined for inter-rater reliability of endoscopic assessment of fundoplication and other upper gastrointestinal pathologies. Methods: An electronic search was completed in Ovid MEDLINE/PubMed, CINAHL, SCOPUS, Cochrane Database of Systematic Reviews and Web of Science. Study characteristics were collated and analyzed. Key Content and Findings: Fifty-two articles of varying quality were included in the review. The studies were reviewed and grouped based on their anatomical/pathological focus as well as the number of observers and statistical correlation coefficients used. Conclusions: This comprehensive review has identified a shortage of literature on the inter-rater reliability of assessing fundoplication on endoscopy. Of the studies included which looked at fundoplication, six out of eight had their design focused on comparison pre- and post-operatively rather than specific reliability of assessors. This area of deficiency provides scope and opportunity for further research to improve reporting of fundoplication with endoscopy.