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01-01-2012 | 2011 SSAT Plenary Presentation

Long-Term Follow-up of Barrett’s Epithelium: Medical Versus Antireflux Surgical Therapy

Authors: Giovanni Zaninotto, Paola Parente, Renato Salvador, Fabio Farinati, Chiara Tieppo, Nicola Passuello, Lisa Zanatta, Matteo Fassan, Francesco Cavallin, Mario Costantini, Claudia Mescoli, Giorgio Battaglia, Alberto Ruol, Ermanno Ancona, Massimo Rugge

Published in: Journal of Gastrointestinal Surgery | Issue 1/2012

Abstract

Background

Barrett’s esophagus (BE) is the most serious complication of GERD. In BE patients, this observational study compares the effects of antireflux surgery versus antisecretory medical therapy.

Methods

Overall, 89 BE patients (long BE = 45; short BE = 44) were considered: 45 patients underwent antireflux surgery and 44 underwent medical therapy. At both initial and follow-up endoscopy, symptoms were assessed using a detailed questionnaire; BE phenotypic changes [intestinal metaplasia (IM) presence/type, Cdx2 expression] were assessed by histology (H&E), histochemistry (HID), and immunohistochemistry. Surgical failures were defined as follows: (1) abnormal 24-h pH monitoring results after surgery, (2) endoscopically evident recurrent esophagitis, and (3) recurrent hiatal hernia or slipped fundoplication on endoscopy or barium swallow.

Results

Reversion of IM was observed in 12/44 SSBE and 0/45 LSBE patients (p < 0.01). Reversion was more frequently observed after effective antireflux surgery than after medical treatment (p = 0.04). In patients with no further evidence of IM after therapy, Cdx2 expression was also absent (p = 0.02). The extent of IM was reduced, and the IM phenotype improved in SSBE patients after surgery.

Conclusions

Patients with short BE (but not those with long BE) may benefit from surgically reducing the esophagus’ exposure to GE reflux; among these patients, successful surgery carries a higher IM reversion rate than medical treatment.

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Title: Long-Term Follow-up of Barrett’s Epithelium: Medical Versus Antireflux Surgical Therapy
Authors: Giovanni Zaninotto
Paola Parente
Renato Salvador
Fabio Farinati
Chiara Tieppo
Nicola Passuello
Lisa Zanatta
Matteo Fassan
Francesco Cavallin
Mario Costantini
Claudia Mescoli
Giorgio Battaglia
Alberto Ruol
Ermanno Ancona
Massimo Rugge
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 1/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1739-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-Term Follow-up of Barrett’s Epithelium: Medical Versus Antireflux Surgical Therapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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