Post-operative HRIM and FLIP for dysphagia following antireflux procedures

Post-operative dysphagia after an antireflux procedure is a common problem that requires a thorough evaluation of anatomy and physiology to determine whether the complaint is due to obstruction at the esophagogastric junction or a defect in peristalsis that was either missed or underestimated during the pre-operative assessment. Many tools are helpful in this assessment and the first step is to assess the anatomy of the EGJ as antireflux procedures focus primarily on attempting to augment the barrier function of this anatomic zone. This can be accomplished with a careful endoscopy or a barium esophagram to determine whether the antireflux procedure is intact or potentially disrupted with or without herniation. Additionally, these tools are also important in ruling out strictures and other mechanical problems related to the various endoscopic and surgical approaches.