Post written by Shou-jiang Tang, MD, from the Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
We report and describe a previously unrecognized pathology called postfundoplication submucosal prolapse syndrome (PFSPS); we coined the terminology based on the imaging and pathological findings. We hypothesized that the mucosa and submucosal layers around the GE junction and within the surgical wraps developed chronic prolapse, and they moved distally and retracted back repeatedly.
We believe that postfundoplication SPS is an under-recognized condition by gastroenterologists and surgeons. The differential diagnosis includes fundoplication hiatal stenosis, twisted and/or slipped fundoplication, para-esophageal herniation, or neoplastic process around the GE junction. Postfundoplication hiatal stenosis develops immediately or very early after fundoplication, and there is not associated submucosal thickening. Patient symptoms and careful endoscopic examination of the surgical wrap with selective incorporation of EUS are the keys in the diagnosis and management of postfundoplication dysphagia.
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