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Surgical Endoscopy

Published in:

01-09-2016

Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus

Authors: Ognjan Skrobić, Aleksandar Simić, Nebojša Radovanović, Nenad Ivanović, Marjan Micev, Predrag Peško

Published in: Surgical Endoscopy | Issue 9/2016

Abstract

Objective

HALO radiofrequency ablation (RFA) has been proven as safe and efficient in eradication of both non- and dysplastic Barrett’s esophagus (BE). Definitive post-RFA treatment is yet to be determined.

Methods

RFA was performed in 56 patients with BE, 38 with intestinal metaplasia (IM) and 18 with low-grade dysplasia (LGD), and repeated in case of residual BE. Length of the BE was classified according to C&M criteria. Follow-up included regular upper GI endoscopies with biopsies 6 months, 1 and 2 years after the complete resolution of BE. Patients were divided into two groups regarding post-RFA treatment: those maintaining proton pump inhibitors (PPI) daily and those submitted to laparoscopic Nissen fundoplication (LNF) at least 3 months after BE eradication or synchronous with RFA.

Results

There were no perforations or strictures related to RFA. Complete endoscopic resolution of BE was observed in 83.92 % patients (86.84 % IM and 77.77 % LGD), in 25 that maintained PPI and 22 in whom LNF was done. In PPI group, 2-year follow-up revealed BE recurrence in biopsy samples in 20 % of patients, while in LNF group 9.1 % of patients had recurrent IM. In overall sample of patients, no difference was noted regarding the influence of post-RFA treatment (p < 0.423). LNF proved superiority over PPI treatment in patients with long-segment BE (cutoff C > 4 cm, p < 0.021).

Conclusion

HALO RFA is a safe procedure, with high rate of success in complete eradication of BE in symptomatic GERD patients. LNF provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first line of treatment after HALO RFA.

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Title: Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus
Authors: Ognjan Skrobić
Aleksandar Simić
Nebojša Radovanović
Nenad Ivanović
Marjan Micev
Predrag Peško
Publication date: 01-09-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4677-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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