Case Study: First Ever Visualization of Esophagogastric Junction Following Endoscopic Fundoplication in an Awake Patient Using Magnetically Controlled Capsule Endoscopy

Background: Endoscopic retroflexion evaluates the gastroesophageal junction (GEJ) which is traversed by the gastroscope in a sedated patient. Magnetically Controlled Capsule Endoscopy (MCCE) examines the GEJ in a collapsed natural state in awake patients. This report is the first-ever visualization of endoscopic fundoplication status post transoral incisionless fundoplication (TIF) without gastroscope or sedation. Case Description: This patient is a 69-year-old female with recurrent antral gastritis. She underwent laparoscopic hiatal hernia repair and concomitant TIF (cTIF) in 2019. She tolerated swallowing the MCCE capsule well. As we guided the MCCE to evaluate the cardia, we observed the first visualization of a collapsed postoperative TIF valve. She had no adverse events and was discharged 30 minutes post-procedure. Discussion: MCCE has the advantage of avoiding sedation and its risks. There is no need to stop critical medications, including anticoagulants. MCCE has a short duration, enabling the physician to show high-resolution images and discuss the plan with an awake patient who can drive after the procedure. The use of MCCE in evaluating the reconstructed postoperative valve is promising. It enables visualization of the valve in its natural position, can measure the length of the valve, and has the potential to perform dynamic evaluation of the GEJ in an awake patient. Conclusion: The Magnetically Controlled Capsule Endoscopy system evaluates the original and reconstructed gastroesophageal valve in its natural status without sedation. It can potentially enhance the understanding of GERD and its surgical treatment.