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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2014

01-12-2014

The impact of laparoscopic anti-reflux surgery in patients with Barrett’s esophagus

Authors: Ellen Morrow, Daniel Bushyhead, Eelco Wassenaar, Marcelo Hinojosa, Maximiliano Loviscek, Carlos Pellegrini, Brant Oelschlager

Published in: Surgical Endoscopy | Issue 12/2014

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Abstract

Background

Barrett’s esophagus (BE) is a major risk factor for esophageal adenocarcinoma. It is believed that BE is caused by chronic gastro-esophageal reflux disease (GERD). Laparoscopic anti-reflux surgery (LARS) restores the competency of the cardia and may thereby change the natural course of BE. We studied the impact of LARS on the histological profile of BE and on the control of GERD.

Methods

We identified all patients with BE who underwent LARS from 1994 to 2007 and contacted them to assess post-operative GERD symptoms via questionnaire. Endoscopy findings, histology, 24 hour pH monitoring, and manometry were also collected using our prospectively maintained database. Histological regression was defined as either loss of dysplasia or disappearance of BE.

Results

Two hundred and fifteen patients met the initial inclusion criteria; in 82 of them histology from post-operative endoscopy was available for review. Endoscopy was performed a median of 8 years (range, 1–16 years) after surgery. Regression of BE occurred in 18 (22 %) patients while in 6 (7 %) BE progressed to dysplasia or cancer. Thirty-six (43 %) patients underwent pre- and post-operative manometry. The median lower esophageal sphincter pressure increased from 9 to 17 mmHg in these patients. Thirty-four (41 %) patients underwent pre- and post-operative pH studies. The median DeMeester score decreased from 54 to 9. Sixty-seven (82 %) of 82 patients completed the post-operative questionnaire; 86 % of these patients reported improvement in heartburn and regurgitation.

Conclusions

LARS was associated with both physiologic and symptomatic control of GERD in patients with BE. LARS resulted in regression of BE in 22 % of patients and progression in 7 %. Thus, continued surveillance of Barrett’s is needed after LARS.
Literature
1.
Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O’Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J (2014) Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. Gut 63(1):7–42PubMedCrossRef
2.
Zehetner J, DeMeester SR, Ayazi S, Costales JL, Augustin F, Oezcelik A, Lipham JC, Sohn HJ, Hagen JA, DeMeester TR (2010) Long-term follow-up after anti-reflux surgery in patients with Barrett’s esophagus. J Gastrointest Surg 14(10):1483–1491PubMedCrossRef
3.
Sikkema M, Looman CW, Steyerberg EW, Kerkhof M, Kastelein F, van Dekken H, van Vuuren AJ, Bode WA, van der Valk H, Ouwendijk RJ, Giard R, Lesterhuis W, Heinhuis R, Klinkenberg EC, Meijer GA, ter Borg F, Arends JW, Kolkman JJ, van Baarlen J, de Vries RA, Mulder AH, van Tilburg AJ, Offerhaus GJ, ten Kate FJ, Kusters JG, Kuipers EJ, Siersema PD (2011) Predictors for neoplastic progression in patients with Barrett’s esophagus: a prospective cohort study. Am J Gastroenterol 106(7):1231–1238PubMedCrossRef
4.
Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA (2003) Clinical and pathologic response of Barrett’s esophagus to laparoscopic antireflux surgery. Ann Surg 238(4):458–464PubMedCentralPubMed
5.
Hofstetter WL, Peters JH, DeMeester TR, Hagen JA, DeMeester SR, Crookes PF, Tsai P, Banki F, Bremner CG (2001) Long-term outcome of antireflux surgery in patients with Barrett’s esophagus. Ann Surg 234(4):532–538PubMedCentralPubMedCrossRef
6.
Chang EY, Morris CD, Seltman AK, O’Rourke RW, Chan BK, Hunter JG, Jobe BA (2007) The effect of antireflux surgery on esophageal carcinogenesis in patients with Barrett esophagus: a systematic review. Ann Surg 246(1):11–21PubMedCentralPubMedCrossRef
7.
Kauer WKH, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen JA (1995) 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 222(4):525–533PubMedCentralPubMedCrossRef
8.
Parilla P, Martínez de Haro LF, Ortiz A, Munitiz V, Molina J, Bermejo J, Canteras M (2003) Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg 237(3):291–298
9.
Rees JRE, Lao-Sirieix P, Wong A, Fitzgerald RC (2011) Treatment for Barrett’s oesophagus. Cochrane Database Syst Rev doi:10.​1002/​14651858
10.
11.
Goldblum JR, Lauwers GY (2002) Dysplasia arising in Barrett’s esophagus: diagnostic pitfalls and natural history. Semin Diagn Pathol 19(1):12–19PubMed
12.
Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (2011) American gastroenterological association technical review on the management of Barrett’s esophagus. Gastroenterology 140(3):e18–e52PubMedCentralPubMedCrossRef
13.
Sharma FalkGW, Weston AP, Reker D, Johnston M, Sampliner RE (2006) Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 4(5):566–572PubMedCrossRef
14.
Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. New Engl J Med 365:1375–1383PubMedCrossRef
15.
Millind R, Attwood SE (2012) Natural history of Barrett’s esophagus. World J Gastroenterol 18(27):3483–3491CrossRef
16.
Curvers WL, Ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, Bohmer C, Mallant-Hent RC, van Oijen A, Naber AH, Scholten P, Busch OR, Blaauwgeers HG, Meijer GA, Bergman JJ (2010) Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol 105:1523–1530PubMedCrossRef
17.
Ajumobi A, Bahjri K, Jackson C, Griffin R (2010) Surveillance in Barrett’s esophagus: an audit of practice. Dig Dis Sci 55(6):1615–1621PubMedCrossRef
Metadata
Title
The impact of laparoscopic anti-reflux surgery in patients with Barrett’s esophagus
Authors
Ellen Morrow
Daniel Bushyhead
Eelco Wassenaar
Marcelo Hinojosa
Maximiliano Loviscek
Carlos Pellegrini
Brant Oelschlager
Publication date
01-12-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3601-z

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