Article Title

Lack of diagnostic efficacy of endoscopy for paraoesophageal hiatus hernia


Background: Hiatal hernia is a common finding on endoscopy; clinical management and prognosis differ significantly depending on its type. Symptomatic paraoesophageal hiatus hernia (PEH) (type II–IV) usually require surgery whereas sliding hiatal hernia (type I) associated with reflux disease can be frequently medically managed. We examined the accuracy of gastroscopy and barium contrast meal [upper gastrointestinal (GI) study] in the diagnosis of PEH and gastric volvulus (GV).

Methods: The reports of gastroscopy and barium meal in patients who underwent laparoscopic fundoplication were compared with intraoperative finding of PEH in a retrospective cohort of consecutive patients with PEH treated between January 1st 2008 to 2017.

Results: PEH was diagnosed in 231 consecutive patients; 130 patients were eligible for the study. Endoscopy and barium meal reports were both available in 60 patients, endoscopy in 24 and barium meal in 46 patients. Sensitivity of endoscopy and barium study in diagnosing the presence of hiatal hernia were 97.61% and 100% respectively. Despite this, both endoscopy and barium study were unreliable for type of hiatal hernia with sensitivity of 8.33% and 38.68% respectively. The sensitivity of endoscopy and barium study in diagnosing chronic GV (CGV) were 10.7% and 20.5% respectively.

Conclusions: The anatomical description lacked consistency with both endoscopy and radiology reporting; standardisation of reporting may increase the reliability of these tests. Identification of the type of hiatus hernia (HH) is important to accurately risk stratify the disease together with patient symptoms. Both barium meal and endoscopy had poor sensitivity in detecting the type of HH but highly sensitive for diagnosing the presence of HH.


giant hiatus hernia (GHH), paraoesophageal hiatus hernia (PEH), endoscopy

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