assessment. However, majority of endoscopic assessment done in the community do not describe the fundoplication adequately. An audit of reported endoscopic ndings by community gastroenterologists by Juhasz etal. [3] revealed a shockingly low con­cordance with subsequent ndings of an experienced foregut surgeon. Surprisingly they found that nearly a 1/3rd of the endoscopic reports did not even mention a previ­ous fundoplication while majority of the reports simply stated, “fundoplication changes noted” without any specic description. Proper and uniform endoscopic assessment of fundoplication is an import aspect in assessing causes of failure and devising a man­agement strategy. Various terminologies have been used to describe failed fundoplica­tion anatomy. Most commonly terms such as recurrent hiatus hernia, slipped, intra-thoracic, disrupted, twisted and telescopic fundoplication have been used. They have also been used interchangeably without accepted denitions. For example one may classify an intra-thoracic fundoplication is “slipped into the chest” or “telescoping in to the chest” while a fundoplication at the hiatus with GEJ above the hiatus may be called “ slipped below the GJ” or recurrent HH” or “misplaced fundoplication”.

not uncommon for patients with failed fundoplication to not have had an adequate documentation of disease prior to surgery. In these patients, it is hazardous to guess whether the surgery has failed or the disease never existed.