Top

Journal of Gastrointestinal Surgery

Published in:

01-10-2008 | ssat plenary presentation

Medical or Surgical Management of GERD Patients with Barrett’s Esophagus: The LOTUS Trial 3-Year Experience

Authors: S. E. Attwood, L. Lundell, J. G. Hatlebakk, S. Eklund, O. Junghard, J.-P. Galmiche, C. Ell, R. Fiocca, T. Lind

Published in: Journal of Gastrointestinal Surgery | Issue 10/2008

Abstract

Introduction

The long-term management of gastroesophageal reflux in patients with Barrett’s esophagus (BE) is not well supported by an evidence-based consensus. We compare treatment outcome in patients with and without BE submitted to standardized laparoscopic antireflux surgery (LARS) or esomeprazole treatment.

Methods

In the Long-Term Usage of Acid Suppression Versus Antireflux Surgery trial (a European multicenter randomized study), LARS was compared with dose-adjusted esomeprazole (20–40 mg daily). Operative difficulty, complications, symptom outcomes [Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD)], and treatment failure at 3 years and pH testing (after 6 months) are reported.

Results

Of 554 patients with gastroesophageal reflux disease, 60 had BE—28 randomized to esomeprazole and 32 to LARS. Very few BE patients on either treatment strategy (four of 60) experienced treatment failure during the 3-year follow-up. Esophageal pH in BE patients was significantly better controlled after surgical treatment than after esomeprazole (p = 0.002), although mean GSRS and QOLRAD scores were similar for the two therapies at baseline and at 3 years. Although operative difficulty was slightly greater in patients with BE than those without, there was no difference in postoperative complications or level of symptomatic reflux control.

Conclusion

In a well-controlled surgical environment, the success of LARS is similar in patients with or without BE and matches optimized medical therapy.

Stein HJ, Kauer WK, Feussner H, Siewert JR. Bile reflux in benign and malignant Barrett’s esophagus: effect of medical acid suppression and nissen fundoplication. J Gastrointest Surg 1998;2(4):333–341. doi:10.1016/S1091-255X(98)80072-3.PubMedCrossRef

Katzka D, Castell D. Successful elimination of reflux symptoms does not insure adequate control of acid reflux in patients with Barrett’s esophagus. Am J Gastro 1994;89:989–991.

Sarela AI, Hick DG, Verbeke CS, Casey JF, Guillou PJ, Claark GW. Persistent acid and bile reflux in asymptomatic patients with Barrett’s esophagus receiving proton pump inhibitors. Arch Surg 2004;139:547–551. doi:10.1001/archsurg.139.5.547.PubMedCrossRef

Desai KM, Soer NJ, Frisella MM, Quasebarth MA, Dunnegan DL, Brunt LM. Efficacy of laparoscopic antireflux surgery in patients with Barrett’s esophagus. Am J Surg 2003;186:652–659. doi:10.1016/j.amjsurg.2003.08.009.PubMedCrossRef

Csendes A. Surgical treatment of Barrett’s esophagus 1980–2003. World J Surg 2004;28:225–231. doi:10.1007/s00268-003-6986-8.PubMedCrossRef

Csendes A, Braghetto I, Burdiles P, Puente G, Korn O, Diasz JC, et al. Long term results of classic antireflux surgery in 152 patients with Barrett’s esophagus: clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation. Surgery 1998;123:545–557. doi:10.1067/msy.1998.86985.CrossRef

Csendes A, Burdiles P, Braghetto I, Smok G, Castro C, Korn O, et al. Dysplasia and adenocarcinoma after classic antireflux surgery in patients with Barrett’s esophagus: the need for long-term subjective and objective follow-up. Ann Surg 2002;235(2):178–185. doi:10.1097/00000658-200202000-00004.PubMedCrossRef

Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Thor K, Lamm M, et al. Long-term management of gastro-oesophageal reflux disease with omeprazole or open antireflux surgery: results of a prospective, randomized clinical trial. Eur J Gastroenterol Hepatol 2000;12:879–887.PubMedCrossRef

Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Liedman B, Hatlebakk JG, et al. Continued (5 year) follow up of a randomised clinical study comparing anti reflux surgery and omeprazole in gastro-esophageal reflux disease. J Am Coll Surg 2001;192:172–179. doi:10.1016/S1072-7515(00)00797-3.PubMedCrossRef

10.

Attwood S, Lundell L, Hatlebakk JG, Ell C, Fiocca R, Galmiche JP, et al. Standardization of surgical technique in laparoscopic anti-reflux surgery: The Lotus trial experience. World J Surg 2008; 32:995–998.

11.

Miner P Jr, Katz PO, Chen Y, Sostek M. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole: a five-way cross-over study. Am J Gastroenterol 2003;98:2616–2620. doi:10.1111/j.1572-0241.2003.08783.x.PubMedCrossRef

12.

Lundell L, Attwood S, Ell C, Fiocca R, Galmiche JP, Hatlebakk J, et al. Comparing laparoscopic anti-reflux surgery to esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: A 3-year interim analysis of the LOTUS trial. Gut. 2008; doi:10.1136/gut.2008.148333.

13.

Lundell L, Dent J, Bennett JR, et al. Endoscopic assessment of esophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172–180.PubMedCrossRef

14.

Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology 1996;110(2):614–621. doi:10.1053/gast.1996.v110.agast960614.PubMedCrossRef

15.

Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the gastrointestinal symptom rating scale in patients with gastroesophageal reflux disease. Qual Life Res 1998;7:75–83. doi:10.1023/A:1008841022998.PubMedCrossRef

16.

Wiklund IK, Junghard O, Grace E, et al. Quality of Life in reflux and dyspepsia patients. Psychometric documentation of a new disease-specific questionnaire (QOLRAD). Eur J Surg (Suppl) 1998;583:41–49. doi:10.1080/11024159850191238.CrossRef

17.

Kahrilas PJ, Pandolfino JE. Hiatus hernia in the esophagus, 4th edn. Ed. Costell DO, Richter JE. Philadelphia 2004, pp 389–407.

18.

O’Riordan JM, Byrne PJ, Ravi N, Keeling PW, Reynolds JV. Long term clinical and pathologic response of Barrett’s esophagus after antireflux surgery. Am J Surg 2004;188:27–33. doi:10.1016/j.amjsurg.2003.10.025.PubMedCrossRef

19.

Bowers SP, Mattar SG, Smith CD, Waring JP, Hunter KG. Clinical and histologic follow up after antireflux surgery for Barrett’s esophagus. J Gastrointest Surg 2002;6:532–538. doi:10.1016/S1091-255X(02)00033-1.PubMedCrossRef

20.

Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, et al. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 1999;3:292–300. doi:10.1016/S1091-255X(99)80071-7.PubMedCrossRef

21.

Hofstetter WL, Peters JH, DeMeester TR, Hagen JA, DeMeester SR, Crookes PF, et al. Long term outcome of antireflux surgery in patients with Barrett’s esophagus. Ann Surg 2001;234:532–538. doi:10.1097/00000658-200110000-00012.PubMedCrossRef

22.

Abbas AE, Deschamps C, Cassivi SD, Allen MS, Nicholas FC 3rd, Miller DI, Pairolero PC. Barrett’s esophagus: the role of fundoplication. Ann Thorac Surg 2004;77:393–396. doi:10.1016/S0003-4975(03)01352-3.PubMedCrossRef

23.

Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA. Clinical and pathologic response of Barrett’s esophagus to laparoscopic antireflux surgery. Ann Surg 2003;238:458–464.PubMed

24.

Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, et al. Barrett’s esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg 2003;196:706–713. doi:10.1016/S1072-7515(03)00147-9.PubMedCrossRef

25.

Martinez de Haro PP, Ortiz A, Munitiz V, Molina J, Bermejo J, Canteras M. Long term results of a prospective randomised study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg 2003;237:291–298. doi:10.1097/00000658-200303000-00001.PubMedCrossRef

26.

Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. N Engl J Med 1992;326:786–792.PubMed

27.

Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long term outcome of medical and surgical therapies for gastroesophageal reflux disease. Follow-up of a randomised controlled trial. JAMA 2001;285:2331–2338. doi:10.1001/jama.285.18.2331.PubMedCrossRef

28.

Attwood SEA, Barlow AP, Norris TL, Watson A. Barrett’s oesophagus: the effect of anti-reflux surgery on symptom control and the development of complications. Br J Surg 1992;79:1021–1024.

29.

Ortiz A, Martinez de Haro LF, Parrilla P, et al. Conservative treatment versus antireflux surgery in Barrett’s esophagus: long-term results of a prospective study. Br J Surg 1996;83:274–278. doi:10.1002/bjs.1800830242.PubMedCrossRef

30.

Mahon D, Rhodes M, Decadt B, Hindmarsh A, Lowndes R, Beckingham I, et al. Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg 2005;92(10):1298.

31.

Labenz J, Nocon M, Lind T, Leodolter A, Jaspersen D, Meyer-Sabellek W, et al. Prospective follow-up data from the ProGERD study suggest that GERD is not a categorical disease. Am J Gastroenterol 2006;101:2457–2462.PubMed

32.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900–1920. doi:10.1111/j.1572-0241.2006.00630.x.PubMedCrossRef

33.

Farrell TM, Smith CD, Metreveli RE, Johnson AB, Galloway KD, Hunter JG. Fundoplication provides effective and durable symptom relief in patients with Barretts esophagus. Am J Surg 1999;178:18–21. doi:10.1016/S0002-9610(99)00111-7.PubMedCrossRef

34.

O’Boyle CJ, Watson DI, DeBeaux AC, Jamieson GG. Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg 2002;72:471–475. doi:10.1046/j.1445-2197.2002.02455.x.PubMedCrossRef

35.

Hagedorn C, Lönroth H, Rydberg L, Ruth M, Lundell L. Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: Result of a randomized clinical trial. J Gastrointest Surg 2002;4:540–545. doi:10.1016/S1091-255X(02)00037-9.CrossRef

36.

Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006;131(5):1392–1399. doi:10.1053/j.gastro.2006.08.032.PubMedCrossRef

37.

Braghetto I, Csendes A, Burdiles P, Kom O. Antireflux surgery, highly selective vagotomy and duodenal switch procedure: postoperative evolution in patients with complicated and non-complicated Barrett’s esophagus. Dis Esophagus 2000;13:12–17. doi:10.1046/j.1442-2050.2000.00066.x.PubMedCrossRef

38.

Dunnington GL, DeMeester TR. Outcome effect of adherence to operative principles of Nissen fundoplication by multiple surgeons. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. Am J Surg 1993;166(6):654–657. discussion 657-9 doi:10.1016/S0002-9610(05)80673–7.PubMedCrossRef

39.

Viljakka M, Luostarinen M, Isolauri J. Complications of open and laparoscopic anti-reflux surgery. 32-years audit at a teaching hospital. J Am Coll Surg 1997;185:446–450.PubMed

40.

Watson DI, Jamieson GG, Devitt PG, Mitchell PC, Game PA, et al. Para-esophageal hiatus hernia: an important complication of laparoscopic Nissen fundoplication. Br J Surg 1995;82(4):521–523. doi:10.1002/bjs.1800820428.PubMedCrossRef

41.

Peridikis G, Hinder RA, Lund RJ, Rasier F, Katada N. Laparoscopic Nissen fundoplication: Where do we stand. Surg Laparosc Endosc 1997;7:17–21. doi:10.1097/00019509-199702000-00005.CrossRef

42.

Booth MI, Jones L, Stratford J, Dehn TC. Results of laparoscopic Nissen fundoplication at 2–8 years after surgery. Br J Surg 2002;89:476–481. doi:10.1046/j.0007-1323.2002.02074.x.PubMedCrossRef

43.

Sandbu R, Haglund U, Arvidsson D, Hallgren T. Anti-reflux surgery in Sweden, 1987–1997: a decade of change. Scand J Gastroenterol 2000;35:345–348. doi:10.1080/003655200750023886.PubMedCrossRef

44.

Watson DI, Baigrie RJ, Jaimeson GG. A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? Ann Surg 1996;224:198–203. doi:10.1097/00000658-199608000-00013.PubMedCrossRef

45.

Bais JE, Bartelsman JF, Bonjer HJ, Cuesta MA, Go PM, Klinkenberg-Knol EC, et al. Laparoscopic or conventional Nissen fundoplication for gastro esophageal reflux disease. Lancet 2000;355:170–174. doi:10.1016/S0140-6736(99)03097-4.PubMedCrossRef

46.

Loustarinen MES, Isolauri JO. Surgical experience improves the long-term results of Nissen fundoplication. Scand J Gastroenterol 1999;34:117–120. doi:10.1080/00365529950172943.CrossRef

47.

Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G. Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 1994;4:472–483.CrossRef

48.

Madan A, Minocha A. Despite high satisfaction, majority of gastro-oesophageal reflux disease patients continue to use proton pump inhibitors after anti-reflux surgery. Aliment Pharmacol Ther 2006;23:601–605. doi:10.1111/j.1365-2036.2006.02788.x.PubMedCrossRef

49.

Jamieson GG. Antireflux surgery, Barretts esophagus, and adenocarcinoma. Ann Surg 2007;246:22–23. doi:10.1097/SLA.0b013e318070d3b7.PubMedCrossRef

50.

Chang EY, Morris CD, Robert AK, O’Rourke W, Chan B. The effect of antireflux surgery on esophageal cancer in patients with Barrett’s esophagus. Ann Surg 2007;246:11–21. doi:10.1097/01.sla.0000261459.10565.e9.PubMedCrossRef

Title: Medical or Surgical Management of GERD Patients with Barrett’s Esophagus: The LOTUS Trial 3-Year Experience
Authors: S. E. Attwood
L. Lundell
J. G. Hatlebakk
S. Eklund
O. Junghard
J.-P. Galmiche
C. Ell
R. Fiocca
T. Lind
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0645-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Medical or Surgical Management of GERD Patients with Barrett’s Esophagus: The LOTUS Trial 3-Year Experience

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2008

Perioperative Treatment with Infliximab in Patients with Crohn’s Disease and Ulcerative Colitis is Not Associated with an Increased Rate of Postoperative Complications

Re: An Antecolic Roux-En-Y Type Reconstruction Decreased Delayed Gastric Emptying After Pylorus-Preserving Pancreatoduodenectomy by Murakami et al.

Evolution of a Surgeon: A 40-year Perspective

Applying Proteomic-Based Biomarker Tools for the Accurate Diagnosis of Pancreatic Cancer

NOTES Rectosigmoid Resection Using Transanal Endoscopic Microsurgery (TEM) with Transgastric Endoscopic Assistance: A Pilot Study in Swine

Reply to Comments on “An Antecolic Roux-en-Y Reconstruction Decreased Delayed Gastric Emptying After Pylorus-Preserving Pancreatoduodenectomy”