Top

Published in:

01-10-2010 | 2010 SSAT Plenary Presentation

Long-term Follow-up After Anti-reflux Surgery in Patients with Barrett’s Esophagus

Authors: Joerg Zehetner, Steven R. DeMeester, Shahin Ayazi, Jesse L. Costales, Florian Augustin, Arzu Oezcelik, John C. Lipham, Helen J. Sohn, Jeffrey A. Hagen, Tom R. DeMeester

Published in: Journal of Gastrointestinal Surgery | Issue 10/2010

Abstract

Background

Factors associated with the risk of progression of Barrett’s esophagus remain unclear, and the impact of therapy on this risk remains uncertain. The aim of this study was to assess patients followed long-term after anti-reflux surgery for Barrett’s esophagus.

Methods

A retrospective review was performed of all patients with Barrett’s who underwent anti-reflux surgery from 1989 to 2009 and had ≥5 years of follow-up.

Results

There were 303 patients and 75 had follow-up ≥5 years. Median follow-up time for the 75 patients was 8.9 years (range 5–18). Regression was seen in 31%. Progression occurred in 8%, and these patients were significantly more likely to have a failed fundoplication (67% vs. 16%, p = 0.0129). The rate of progression from non-dysplastic Barrett’s to high-grade dysplasia or cancer was 0.8% per patient year, and was seven times higher in patients with a failed fundoplication.

Conclusion

Compared to the accepted rate of progression of non-dysplastic Barrett’s to high-grade dysplasia or cancer of 1.0% per patient year, anti-reflux surgery reduces this rate during long-term follow-up. The rate of progression was significantly lower in patients with an intact compared to a disrupted fundoplication, further suggesting that anti-reflux surgery can alter the natural history of Barrett’s esophagus.

Pohl H, Welch HG: The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005, 97(2):142–146.CrossRefPubMed

Wani S, Puli SR, Shaheen NJ, Westhoff B, Slehria S, Bansal A, Rastogi A, Sayana H, Sharma P: Esophageal adenocarcinoma in Barrett's esophagus after endoscopic ablative therapy: a meta-analysis and systematic review. Am J Gastroenterol 2009, 104(2):502–513.CrossRefPubMed

Sikkema M, de Jonge PJ, Steyerberg EW, Kuipers EJ: Risk of esophageal adenocarcinoma and mortality in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 8(3):235–244; quiz e232.

Ye W, Chow WH, Lagergren J, Yin L, Nyren O: Risk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery. Gastroenterology 2001, 121(6):1286–1293CrossRefPubMed

Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC: The lower esophageal sphincter in health and disease. Am J Surg 1988, 155(1):104–111.CrossRefPubMed

Ayazi S, Lipham JC, Portale G, Peyre CG, Streets CG, Leers JM, Demeester SR, Banki F, Chan LS, Hagen JA et al: Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol 2009, 7(1):60–67.CrossRefPubMed

Barrett NR: The lower esophagus lined by columnar epithelium. Surgery 1957, 41(6):881–894.PubMed

Somerville M, Garside R, Pitt M, Stein K: Surveillance of Barrett's oesophagus: is it worthwhile? Eur J Cancer 2008, 44(4):588–599.CrossRefPubMed

Sharma P, Sidorenko EI: Are screening and surveillance for Barrett's oesophagus really worthwhile? Gut 2005, 54 Suppl 1:i27–i32.CrossRefPubMed

10.

Inadomi JM, Sampliner R, Lagergren J, Lieberman D, Fendrick AM, Vakil N: Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis. Ann Intern Med 2003, 138(3):176–186.PubMed

11.

Das A, Wells C, Kim HJ, Fleischer DE, Crowell MD, Sharma VK: An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett's esophagus. Endoscopy 2009, 41(5):400–408.CrossRefPubMed

12.

Mainie I, Tutuian R, Castell DO: Addition of a H2 receptor antagonist to PPI improves acid control and decreases nocturnal acid breakthrough. J Clin Gastroenterol 2008, 42(6):676–679.CrossRefPubMed

13.

Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO: Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 2001, 120(7):1599–1606.CrossRefPubMed

14.

Schweitzer EJ, Bass BL, Batzri S, Harmon JW: Bile acid accumulation by rabbit esophageal mucosa. Dig Dis Sci 1986, 31(10):1105–1113.CrossRefPubMed

15.

Armstrong D, Rytina ER, Murphy GM, Dowling RH: Gastric mucosal toxicity of duodenal juice constituents in the rat. Acute studies using ex vivo rat gastric chamber model. Dig Dis Sci 1994, 39(2):327–339.

16.

Chiu PW, Ayazi S, Hagen JA, Lipham JC, Zehetner J, Abate E, Oezcelik A, Hsieh CC, DeMeester SR, Banki F et al: Esophageal pH exposure and epithelial cell differentiation. Dis Esophagus 2009, 22(7):596–599.CrossRefPubMed

17.

DeMeester TR, Peters JH, Bremner CG, Chandrasoma P: Biology of gastroesophageal reflux disease: pathophysiology relating to medical and surgical treatment. Annu Rev Med 1999, 50:469–506.CrossRefPubMed

18.

Theisen J, Peters JH, Fein M, Hughes M, Hagen JA, Demeester SR, Demeester TR, Laird PW: The mutagenic potential of duodenoesophageal reflux. Ann Surg 2005, 241(1):63–68.PubMed

19.

Kauer WK, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen JA: Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy re-emphasized. Ann Surg 1995, 222(4):525–531; discussion 531–523.

20.

Oh DS, DeMeester SR, Vallbohmer D, Mori R, Kuramochi H, Hagen JA, Lipham J, Danenberg KD, Danenberg PV, Chandrasoma P et al: Reduction of interleukin 8 gene expression in reflux esophagitis and Barrett's esophagus with antireflux surgery. Arch Surg 2007, 142(6):554–559; discussion 559–560.

21.

Vallbohmer D, DeMeester SR, Oh DS, Banki F, Kuramochi H, Shimizu D, Hagen JA, Danenberg KD, Danenberg PV, Chandrasoma PT et al: Antireflux surgery normalizes cyclooxygenase-2 expression in squamous epithelium of the distal esophagus. Am J Gastroenterol 2006, 101(7):1458–1466.CrossRefPubMed

22.

Babar M, Ennis D, Abdel-Latif M, Byrne PJ, Ravi N, Reynolds JV: Differential molecular changes in patients with asymptomatic long-segment Barrett's esophagus treated by antireflux surgery or medical therapy. Am J Surg, 199(2):137–143.

23.

Katz D, Rothstein R, Schned A, Dunn J, Seaver K, Antonioli D: The development of dysplasia and adenocarcinoma during endoscopic surveillance of Barrett's esophagus. Am J Gastroenterol 1998, 93(4):536–541.CrossRefPubMed

24.

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(4):458-464; discussion 464–456.

25.

Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, DeMeester TR: Barrett's esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg 2003, 196(5):706–712; discussion 712–703.

26.

Hofstetter WL, Peters JH, DeMeester TR, Hagen JA, DeMeester SR, Crookes PF, Tsai P, Banki F, Bremner CG: Long-term outcome of antireflux surgery in patients with Barrett's esophagus. Ann Surg 2001, 234(4):532–538; discussion 538–539.

27.

Parrilla P, Martinez de Haro LF, Ortiz A, Munitiz V, Molina J, Bermejo J, Canteras M: Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett's esophagus. Ann Surg 2003, 237(3):291–298.CrossRefPubMed

28.

Lagergren J, Ye W, Lagergren P, Lu Y: The risk of esophageal adenocarcinoma after antireflux surgery. Gastroenterology 2010: in press.

29.

DeMeester SR, Peters JH, Demeester TR: Barrett's esophagus. Curr Probl Surg 2001, 38(8):558–640.31.

30.

Lagergren J, Viklund P: Is esophageal adenocarcinoma occurring late after antireflux surgery due to persistent postoperative reflux? World J Surg 2007, 31(3):465–469.CrossRefPubMed

Title: Long-term Follow-up After Anti-reflux Surgery in Patients with Barrett’s Esophagus
Authors: Joerg Zehetner
Steven R. DeMeester
Shahin Ayazi
Jesse L. Costales
Florian Augustin
Arzu Oezcelik
John C. Lipham
Helen J. Sohn
Jeffrey A. Hagen
Tom R. DeMeester
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-010-1322-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term Follow-up After Anti-reflux Surgery in Patients with Barrett’s Esophagus

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2010

Radiation Dose from Computed Tomography in Patients with Necrotizing Pancreatitis: How Much Is Too Much?

Involvement of Osteopontin in the Matrix-Degrading and Proangiogenic Changes Mediated by Nicotine in Pancreatic Cancer Cells

TNF-α Induces Vectorial Secretion of IL-8 in Caco-2 Cells

The Incidence and Risk Factors of Post-Laparotomy Adhesive Small Bowel Obstruction

One Hundred Thirty Resections for Pancreatic Neuroendocrine Tumor: Evaluating the Impact of Minimally Invasive and Parenchyma-Sparing Techniques

Relationship of EMAST and Microsatellite Instability Among Patients with Rectal Cancer