In addition to clinical inclusion criteria, general inclusion criteria comprised no contraindications for MRI and age over 18. MR imaging was performed either on a 3.0 T (Magnetom Trio 3T, Siemens Medical Solutions) or on a 1.5 T MRI scanner (Intera, Philips) with a phased array coil placed upon the chest. From 2015 onwards, we then first worked with diluted LumiVision, as it was recommended by the Bender group, followed by application of undiluted LumiVision. Until 2015, we used gadolinium-buttermilk mixture, because LumiVision was not available at that time. The contrast medium and the dose varied with the time. The symptoms recurred at 2–30 months after operation and had existed for 4–35 months at the time of MRI. All patients had undergone laparoscopic antireflux surgery with Nissen fundoplication and presented with new or recurrent symptoms after operation. Five patients underwent more than one MR examination, so 146 MR examinations were evaluated overall. Leading symptoms included heartburn, regurgitation, and dysphagia. An informed consent was waived by the ethics committee.īetween June 2014 and February 2018, 129 patients (61 male, 68 female mean age, 59 years range, 31–73 years) with persistent, recurrent, or new symptoms were enrolled in the study. The feasibility of esophagus visualization with oral administration of a recently developed oral contrast agent LumiVision®, (Bender group) in dilution and undiluted, was compared to the well-known buttermilk-gadolinium mixture during MRI.Įthical approval for this retrospective study of available clinical data was obtained by the Institutional Review Board. It contains no preservatives and no dyes. LumiVision® is a semiliquid preparation of concentrates from pineapple, organic agave syrup, blackcurrant, guar gum, and defoamers. So the purpose of this study was to evaluate different oral contrast agents in MR swallowing studies in symptomatic patients after Nissen fundoplication, and to examine if the buttermilk-gadolinium mixture could be replaced by LumiVision®. In times of public discussions about the toxicity of gadolinium contrast agents, natural substances of fruit juices, which we are used to drink or eat often, may be preferred. Another group used fluids or thickened fluids like buttermilk spiked with gadolinium chelate contrast agents. Other studies dealt with natural contrast agents like pineapple or blueberry juice. Several studies considered different contrast agents to enhance the signal of the digestive tract. Several studies have dealt with this topic, but no unique recommendation concerning the ideal oral contrast agent has been reached. Recent improvements in MR imaging of the gastroesophageal tract allow detection of wrap dysfunction, alterations of esophageal peristalsis, and motility of symptomatic patients after Nissen fundoplication due to GERD. The basic requirements for achieving high image quality in dynamic MR swallowing examinations are complete distention of the esophagus and good contrast between the esophagus and surrounding soft tissue structures as well as appropriate traceability of the oral contrast agent bolus. Dynamic magnetic resonance imaging (MRI) is a new imaging method for the evaluation of the esophagus since technical advances have improved spatial and temporal resolution with reduction of artifacts.
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