A standard scoring system for contrast esophagography following anti-reflux operation

Objective: Contrast esophagram (CE) is commonly performed following anti-reflux operations for gastroesophageal reflux disease (GERD). However, utilization of this procedure is not uniform, and guidelines on its interpretation and clinical relevance are lacking. We hypothesized that a standardized scoring system for interpretation of CE would improve its clinical relevance, particularly when compared to clinical outcomes. Methods: The Maryland Contrast Esophagography Standard Score (MCESS) was developed by a panel of experienced surgeons and radiologists for interpreting relevant portions of the post-operative CE. Seven radiographic and clinical parameters were recorded: dysmotility, persistent contrast column, time for bolus to pass the fundoplication, presence or absence of leak, wrap displacement (technical failure), persistent GE reflux, and pain while swallowing the contrast material. 63 consecutive patients underwent CE within 48 h of operation. MCESS was calculated for each. Clinical outcome data was obtained from review of the medical record during the follow-up period. Clinical outcome measures included length of hospital stay (LoS), need for readmission, and presence or absence of dysphagia at one-month follow-up visit. Pearson correlations were applied to the relationships between the MCESS instrument and clinical outcomes. Results: Fifty-four patients had complete data available for analysis. There were no leaks and no technical failures. LoS averaged 2.5 days (range 1-11 d). Six patients (11.1%) complained of persistent dysphagia at the one-month follow-up visit. Four patients (7.4%) required readmission during the perioperative period. Of the parameters studied, radiographic evidence of GE reflux correlated significantly with LoS and persistent dysphagia at 1 month (p


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Program Number: P249

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