Antireflux Surgery and Risk of Esophageal Adenocarcinoma

Maret-Ouda, John; Könings, Peter; Lagergren, Jesper; Brusselaers, Nele

doi:10.1097/sla.0000000000001438

Cited by 64 publications

(57 citation statements)

References 30 publications

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“…A randomized trial showed that a properly functioning fundoplication is associated with a significantly reduced incidence of Barrett's progression compared to medical therapy . Finally, a systematic review and meta‐analysis concluded that antireflux surgery may prevent adenocarcinoma better than medical therapy in patients with BE, but the risk remains elevated after antireflux surgery . Therefore, cancer prevention appears to be less effective when reflux‐induced damage has already occurred at the molecular level.…”

Section: Surgical Therapymentioning

confidence: 99%

“…98 Finally, a systematic review and meta-analysis concluded that antireflux surgery may prevent adenocarcinoma better than medical therapy in patients with BE, but the risk remains elevated after antireflux surgery. 99 Therefore, cancer prevention appears to be less effective when reflux-induced damage has already occurred at the molecular level. In the future, the possibility that an antireflux operation may alter the natural history of GERD should be considered based on the intuitive concept that stopping both acid and biliary components of reflux could normalize gene expression.…”

Section: Surgical Therapymentioning

confidence: 99%

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Recent advances in Barrett's esophagus

Inadomi

Alastal

Bonavina

et al. 2018

Annals of the New York Academy of Sciences

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Barrett's esophagus (BE) is the only known precursor of esophageal adenocarcinoma, one of the few cancers with increasing incidence in developed countries. The pathogenesis of BE is unclear with regard to either the cellular origin of this metaplastic epithelium or the manner in which malignant transformation occurs, although recent data indicate a possible junctional origin of stem cells for BE. Treatment of BE may be achieved using endoscopic eradication therapy; however, there is a lack of discriminatory tools to identify individuals at sufficient risk for cancer development in whom intervention is warranted. Reduction in gastroesophageal reflux of gastric contents including acid is mandatory to achieve remission from BE after endoscopic ablation, and can be achieved using medical or nonmedical interventions. Research topics of greatest interest include the mechanism of BE development and transformation to cancer, risk stratification methods to identify individuals who may benefit from ablation of BE, optimization of eradication therapy, and surveillance methods to ensure that remission is maintained after eradication is achieved.

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Section: Surgical Therapymentioning

confidence: 99%

Section: Surgical Therapymentioning

confidence: 99%

Recent advances in Barrett's esophagus

Inadomi

Alastal

Bonavina

et al. 2018

Annals of the New York Academy of Sciences

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“…ARS creates a mechanical barrier against all the components of the refluxed gastric contents that, along with reflux of bile and pancreatic juice, have been implicated as possible factors in esophageal carcinogenesis. A meta‐analysis of seven studies of patients with BE showed a decreased pooled EAC incidence rate ratio (IRR) in ARS compared with a medically treated group (IRR 0.46; 95% CI 0.20–1.08) . The subanalysis restricted to the four studies of BE published after the year 2000 indicated a further decreased risk of EAC after ARS compared with medication (IRR 0.26; 95% CI 0.09–0.79).…”

Section: Barrett's Esophagus: From Ppis To Radiofrequency Ablationmentioning

confidence: 99%

Current treatment options for esophageal diseases

Martínek

Akiyama

Vacková

et al. 2016

Annals of the New York Academy of Sciences

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Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.

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“…e. Satisfaction results in a long follow-up (6-9 years) showed better results for patients submitted to surgery, including those who needed PPI, after the surgery compared with the medical treatment only group [10]. f. Anti-reflux surgery probably minimizes the risk of esophageal carcinoma after fundoplication [11].…”

Section: Related To Outcomes [2 4]mentioning

confidence: 99%