Original Report
Multislice computed tomography for the study of complications of gastric fundoplication
Tomografía computarizada multicorte para el estudio de complicaciones de la funduplicatura gástrica
P. Rodríguez Carnero
, A. Herrasti Gallego, C. García Villafañe, R. Méndez Fernández, R. Rodríguez González
Corresponding author
Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain
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Rodríguez Carnero, A. Herrasti Gallego, C. García Villafañe, R. Méndez Fernández, R. Rodríguez González" "autores" => array:5 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Rodríguez Carnero" "email" => array:1 [ 0 => "pablo.rodriguez.carnero@estumail.ucm.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Herrasti Gallego" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "García Villafañe" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Méndez Fernández" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Rodríguez González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tomografía computarizada multicorte para el estudio de complicaciones de la funduplicatura gástrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2276 "Ancho" => 846 "Tamanyo" => 183154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography (MDCT) in a patient with Nissen-fundoplication dehiscence and hernia in the posterior side. (A) Axial image. (B) Oblique coronal reconstruction. (C) Volumetric reconstruction. The study shows the hernia of the posterior side of fundoplication (h). The anterior side of fundoplication (*)–though collapsed can be seen in the right position below the diaphragm. e: esophagus; S: stomach; L: liver.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Gastroesophageal reflux disease (GERD) is the most common cause of esophagitis associated with significant morbidity and is an important source of healthcare spending.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In Spain the annual prevalence of reflux symptoms is 31.6% while 9.8% of the Spanish population shows these symptoms habitually.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Anti-reflux surgery is indicated in patients non-responsive to medical therapy in cases of serious esophagitis (grades <span class="elsevierStyleSmallCaps">iii</span>–<span class="elsevierStyleSmallCaps">iv</span>) and in the presence of respiratory symptoms like asthma, chronic cough or irritation of the pharynx. Nissen type-laparoscopic fundoplication is the elective surgical procedure used in most cases<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> and is also the most widely used laparoscopic modality only second to colecystectomy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Toupet-fundoplication is the most widely used surgical procedure only second to the Nissen type.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The esophageal–gastroduodenal transit (EGDT) is a radiologic modality used to evaluate GERD patients suitable for surgery both preoperatively and when suspicion of early or late fundoplication-related complications or in cases where GERD symptoms relapse. When there is suspicion of fundoplication failure we need to discard partial or complete fundoplication dehiscence, hiatal hernia, fundoplication displacement or the fundoplication being too tight and/or long.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7,8</span></a> It is estimated that fundoplication failure happens between 2% and 30% of cases depending on the definition of failure used by the different groups and the surgical procedure used.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The EGDT has limitations in the study of fundoplications since it does not directly evaluate its leaflets or adjacent soft tissues including diaphragmatic pillars that are in turn very important structures of surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">With multidetector computed tomography (MDCT) the body soft tissues and its representation in space can be studied better. Different study modalities showing the utility of MDCT to assess the esophagus and stomach in different diseases<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–19</span></a> have been published but in very few of these studies CT is used to study anti-reflux surgeries. In this article we describe a new modality for the study of gastroesophageal region with MDCT to evaluate patients going through fundoplications with suspicion of late complication or symptom relapse and think about a new procedure.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Description of modality</span><p id="par0030" class="elsevierStylePara elsevierViewall">Brilliance CT 64-channel<span class="elsevierStyleSup">®</span> (Philips Medical, Eindhoven, Holland) or Optima CT660<span class="elsevierStyleSup">®</span> scanners (GE Healthcare, Milwaukee, WI, USA) were used. Patients were required to fast 4<span class="elsevierStyleHsp" style=""></span>h before the test though they were allowed to drink water. Patients were placed on the CT table in decubitus position with prone position and in the right anterior oblique position–the one most indicated to study the gastroesophageal link and the region of the esophageal hiatus. This position causes a greater intra-abdominal pressure that enhances the visualization of hiatal hernias while eliminating the effect of gravity on the esophageal emptying. Once the digitally reconstructed radiographs are obtained the study of helicoidal MDTC was planned on the body region spanning from 7<span class="elsevierStyleHsp" style=""></span>cm over the domes of the diaphragm to the duodenal frame. Images were acquired through 0.625–2<span class="elsevierStyleHsp" style=""></span>mm cuts, 1–1.375 pitch, 0.75–0.8<span class="elsevierStyleHsp" style=""></span>s rotation, and 120<span class="elsevierStyleHsp" style=""></span>kV with an automatic regulation system of current in the tube. For the studies done in one of the scanners the iterative reconstruction program ASiR<span class="elsevierStyleSup">®</span> (GE Healthcare, Milwaukee, WI, USA) was used.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was given 400<span class="elsevierStyleHsp" style=""></span>ml of oral water-soluble iodinated contrast agent Gastrografin<span class="elsevierStyleSup">®</span> (Bayer Schering Pharma AG, Berlin, Germany) diluted at 4% in a glass with a drinking straw. The patient was instructed to drink this solution in a continuous way and the scanner table was placed in the initial position of the study. The patient was inside the gantry with his feet being the first visible part of his body. When he had drunk more or less half the volume of the contrast agent the process of acquiring images started as he was drinking without interrupting his respiration. When the scanning process was over the patient stopped drinking. No effervescent products, spasmolytic drugs or IV contrast agents were administered.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Then multiplanar and 3D reconstructions of the acquired volume were done.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Use of CT in the study of the esophagus and the stomach has been reported by various authors in various conditions like esophageal neoplasm, achalasia, and esophageal perforation, esophageal stenosis or complication associated with the surgery of obesity.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–19</span></a> Only one group has used TC in patients who undergo fundoplication<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> but with a different modality than ours–with the patient in the decubitus position with prone position while using oral contrast and effervescent powder with a CT scan with a single row of detectors only.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Besides using a 64-channel multislice CT in this modality we are describing we also used oral iodinated contrast before and after the study that facilitates the opacification and distension of the esophagus, the fundoplication and the stomach and allows us to assess each structure with great anatomical detail.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some authors<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,19,20</span></a> use effervescent solutions for the distension of the esophagus though we believe that this is not strictly necessary and because some of these patients show gas retention syndrome,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the administration of gas can be annoying.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Multiplanar and volumetric reconstructions are the tools that allow us to do a 3D study of the corresponding area by easily visualizing the anatomical relation among the esophagus, the fundoplication and the stomach with respect to the diaphragm and the remaining regional structures. They also give us representative images of all complications found that are easier to interpret than EGDT images and also more similar to the findings that can be found during the procedure (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In EGDT studies it can be hard to be precise in the identification of the esophageal link and its location with respect to the diaphragm. Also sometimes the leaflets cannot be distended and it is hard to evaluate its integrity and spot a fundoplication hernia. These new MDCT studies allow us to see the diaphragm and its pillars, the esophageal link and the fundoplication without structure overlapping and outline its leaflets even though they might not be completely distended (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). CT is usually faster than EGDT– an added advantage.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nevertheless MDCT has some limitations with respect to EGDT. It will not give us dynamic information to assess adequately esophagogastric motility. However studies on esophageal nanometry are usually carried out in these patients for a better evaluation of this matter. Another important point here is the dose of radiation administered. Initially we could think that with MDCT the dose of radiation is greater yet an analysis of the data obtained in our center shows that the effective dose of radiation of MDCT studies (4–7<span class="elsevierStyleHsp" style=""></span>mSv) is lower and in a worst case scenario similar to traditional EGDT (5–7<span class="elsevierStyleHsp" style=""></span>mSv). Also when we have used the iterative ASiR<span class="elsevierStyleSup">®</span> reconstruction of images the elective dose can be 1.5<span class="elsevierStyleHsp" style=""></span>mSv only.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In sum we believe it is a promising modality in the study of fundoplication as it allows us to accurately identify the anatomy and possible complications of anti-reflux surgeries. We believe it can be important in the assessment of patients in which surgical reintervention is being considered due to suspicion of late anatomic failure of fundoplication like partial or complete fundoplication dehiscence, hiatus hernias, displacement of fundoplication or a too tight and/or long fundoplication. However the ultimate clinical utility is still to be determined so it will be necessary to do comparative studies with other modalities like EGDTs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical responsibilities</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of people and animals</span><p id="par0080" class="elsevierStylePara elsevierViewall">Authors confirm that for this investigation no experiments with human beings or animals have been carried out.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data confidentiality</span><p id="par0085" class="elsevierStylePara elsevierViewall">Authors confirm that the protocols of their centers have been followed on matters concerning the publishing of data from patients. They also confirm that all patients included in this study have been given enough information and handed over their written informed consent for their participation in this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Informed consent</span><p id="par0090" class="elsevierStylePara elsevierViewall">Authors confirm that in this report there are no personal data from patients.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Author</span><p id="par0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0155" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: PRC, AHG, CGV, RRG and RMF.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Original Idea of the Study: RRG.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Study Design: PRC, AHG, CGV and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Data Mining: PRC, AHG and CGV.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation: PRC, AHG and CGV, RMF and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Statistical Analysis: NS.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0130" class="elsevierStylePara elsevierViewall">Reference Search: PRC, AHG, CGV and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Writing: PRC, AHG and CGV.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0140" class="elsevierStylePara elsevierViewall">Manuscript critical review with intellectually relevant contributions: RMF and RRG.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0145" class="elsevierStylePara elsevierViewall">Final Version Approval: PRC, AHG, CGV, RMF and RRG.</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">Authors reported no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres384945" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec363762" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres384944" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec363761" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of modality" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Author" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-01" "fechaAceptado" => "2012-06-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec363762" "palabras" => array:3 [ 0 => "Multislice computed tomography" 1 => "Fundoplication" 2 => "Postoperative complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec363761" "palabras" => array:3 [ 0 => "Tomografía computarizada multicorte" 1 => "Funduplicatura" 2 => "Complicaciones postoperatorias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The traditional approach to the imaging evaluation of patients after gastric fundoplication is an upper gastrointestinal series obtained by fluoroscopy. In this article, we describe a new technique using multislice computed tomography that we think can be useful to evaluate patients with suspected complications or late failure after gastric fundoplication.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La técnica de imagen tradicionalmente empleada para valorar a los pacientes con cirugía de funduplicatura y sospecha de complicación es el tránsito esofagogastroduodenal con fluoroscopia. En este artículo describimos una nueva técnica mediante tomografía computarizada multicorte, que puede ser una herramienta útil para estudiar las funduplicaturas con sospecha de complicación o fallo tardío.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez Carnero P, Herrasti Gallego A, García Villafañe C, Méndez Fernández R, Rodríguez González R. Tomografía computarizada multicorte para el estudio de complicaciones de la funduplicatura gástrica. Radiología. 2014;56:435–439.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2276 "Ancho" => 846 "Tamanyo" => 183154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography (MDCT) in a patient with Nissen-fundoplication dehiscence and hernia in the posterior side. (A) Axial image. (B) Oblique coronal reconstruction. (C) Volumetric reconstruction. The study shows the hernia of the posterior side of fundoplication (h). The anterior side of fundoplication (*)–though collapsed can be seen in the right position below the diaphragm. e: esophagus; S: stomach; L: liver.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2209 "Ancho" => 753 "Tamanyo" => 192925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography (MDCT) in a patient with thoracic hernia due to Toupet-fundoplication. (A) Oblique coronal reconstruction. (B) Oblique sagittal reconstruction. (C) Volumetric reconstruction. The leaflets filled up with the oral contrast agent can be seen here (*). Here the leaflets are not surrounding the esophagus since this is a Toupet-fundoplication (270° approximately). In the volumetric reconstruction we can see that compared to the left flap the right one (white arrow points) is slightly detached from the esophagus. In reparative surgery this flap was not surrounding the esophagus appropriately. e: esophagus; S: stomach.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.E. Everhart" 1 => "C.E. Ruhl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2008.12.015" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2009" "volumen" => "136" "paginaInicial" => "376" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19124023" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of health resources and loss of productivity in gastroesophageal reflux disease: results of a cross-sectional study in a primary care setting in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Nuevo" 1 => "M. Tafalla" 2 => "J. Zapardiel" 3 => "J.P. Gisbert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aprim.2010.09.009" "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "474" "paginaFinal" => "481" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382650" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Díaz-Rubio" 1 => "C. Moreno-Elola-Olaso" 2 => "E. Rey" 3 => "G.R. Locke 3rd" 4 => "F. Rodríguez-Artalejo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "95" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14687171" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento laparóscopico del reflujo gastroesofágico: funduplicatura de Nissen, Nissen-Rosseti y Toupet" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Morales Conde" 1 => "S. Morales Méndez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cirugía endoscópica. Guías clínicas de la Asociación Española de Cirujanos" "paginaInicial" => "305" "paginaFinal" => "315" "serieFecha" => "2003" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "When fundoplication fails: redo?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.D. Smith" 1 => "D.A. McClusky" 2 => "M.A. Rajad" 3 => "A.B. Lederman" 4 => "J.G. Hunter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2005" "volumen" => "241" "paginaInicial" => "861" "paginaFinal" => "869" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15912035" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The present state of esophageal laparoscopic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.M. Martínez Regueira" 1 => "F. Rotellar" 2 => "J. Baixauli" 3 => "V. Valentí" 4 => "A. Gil" 5 => "J.L. Hernández-Lizoain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "2005" "volumen" => "28" "numero" => "Suppl. 3" "paginaInicial" => "S11" "paginaFinal" => "S19" "itemHostRev" => array:3 [ "pii" => "S0378512212002265" "estado" => "S300" "issn" => "03785122" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. Hunter" 1 => "C.D. Smith" 2 => "G.D. Branum" 3 => "J.P. Waring" 4 => "T.L. Trus" 5 => "M. Cornwell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1999" "volumen" => "230" "paginaInicial" => "595" "paginaFinal" => "604" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10522729" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomic fundoplication failure after laparoscopic antireflux surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.J. Soper" 1 => "D. Dunnegan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1999" "volumen" => "229" "paginaInicial" => "669" "paginaFinal" => "676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10235525" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastroesophagel reflux disease: integrating the barium esophagram before and after antireflux surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Baker" 1 => "D.M. Einstein" 2 => "B.R. Herts" 3 => "E.M. Remer" 4 => "G.A. Motta-Ramirez" 5 => "E. Ehrenwald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2432050057" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2007" "volumen" => "243" "paginaInicial" => "329" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17384237" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophagel stenosis: three-dimensional multidetector CT and virtual endoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Carrascosa" 1 => "C. Capuñay" 2 => "E. Martín López" 3 => "G. Salis" 4 => "S. Mazzadi" 5 => "J. Carrascosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00261-008-9435-1" "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "19" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18709406" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dedicated multi-detector CT of the esophagus: spectrum of diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ba-Ssalamah" 1 => "J. Zacherl" 2 => "I.M. Noebauer-Huhmann" 3 => "M. Uffmann" 4 => "W.K. Matzek" 5 => "K. Pinker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00261-007-9290-5" "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "3" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17653787" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three-dimensional MDCT imaging and CT esophagography for evaluation of esophageal tumors: preliminary study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. Kim" 1 => "J.M. Lee" 2 => "J.K. Han" 3 => "Y.H. Kim" 4 => "J.Y. Lee" 5 => "H.J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-006-0337-8" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "2418" "paginaFinal" => "2426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16775691" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Yamabe" 1 => "Y. Kuroki" 2 => "T. Ishikawa" 3 => "K. Miyakawa" 4 => "S. Kuroki" 5 => "R. Sekiguchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2008" "volumen" => "191" "paginaInicial" => "753" "paginaFinal" => "757" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "3D gastric computed tomography as a new imaging in patients with failure or complication afer bariatric surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Blanchet" 1 => "C. Mesmann" 2 => "M. Yanes" 3 => "S. Lepage" 4 => "D. Marion" 5 => "P. Gelas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-010-0256-2" "Revista" => array:6 [ "tituloSerie" => "Obes Surg" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "1727" "paginaFinal" => "1733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20730506" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophagography for the evaluation of suspected esophageal perforation or ruptura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Fadoo" 1 => "D.E. Ruiz" 2 => "S.K. Dawn" 3 => "W.R. Webb" 4 => "M.B. Gotway" 5 => "C.T. Helical" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2004" "volumen" => "182" "paginaInicial" => "1177" "paginaFinal" => "1179" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.C. Chandler" 1 => "G. Srinivas" 2 => "K.N. Chintapalli" 3 => "W.H. Schwesinger" 4 => "S.R. Prasad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2008" "volumen" => "190" "paginaInicial" => "122" "paginaFinal" => "135" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal anatomy and complications after gastric bypass surgery: helical CT findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Yu" 1 => "M.A. Turner" 2 => "S.R. Cho" 3 => "A.S. Fulcher" 4 => "E.J. DeMaria" 5 => "J.M. Kellum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2313030546" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2004" "volumen" => "231" "paginaInicial" => "753" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15163816" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of morbid obesity procedures and their complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.W. Trenkner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00261-008-9389-3" "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "335" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18365268" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophageal cancer characterization with pneumo-64-MDCT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Ulla" 1 => "E.M. Gentile" 2 => "D. Cavadas" 3 => "E.L. Yeyati" 4 => "L. Frank" 5 => "J.I. Argerich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00261-011-9784-z" "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "501" "paginaFinal" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21842399" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT of Nissen's fundoplication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Pavone" 1 => "A. Laghi" 2 => "C. Catalano" 3 => "G. Cardone" 4 => "A. Messina" 5 => "T. Neri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "1997" "volumen" => "22" "paginaInicial" => "457" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9233875" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000005600000005/v1_201411230009/S2173510714000470/v1_201411230009/en/main.assets" "Apartado" => array:4 [ "identificador" => "8098" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000005600000005/v1_201411230009/S2173510714000470/v1_201411230009/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510714000470?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 June | 1 | 1 | 2 |
| 2024 April | 1 | 0 | 1 |
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| 2018 February | 14 | 2 | 16 |
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| 2017 June | 29 | 12 | 41 |
| 2017 May | 29 | 5 | 34 |
| 2017 April | 36 | 13 | 49 |
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| 2016 May | 38 | 14 | 52 |
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| 2015 June | 18 | 4 | 22 |
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