Antireflux surgery is required after endoscopic treatment for Barrett’s esophagus

Abstract

Introduction: Barrett's esophagus – is an acquired condition that develops as a result of replacement of normal stratified squamous epithelium in the lower part of the esophagus with columnar epithelium. Barrett's esophagus is considered to be complication by gastroesophageal reflux disease (GERD). Various endoscopic techniques have been shown to be successful in treatment of this condition. However, long term success in preventing further dysplasia is not clear. Biological welding - controlled action of high frequency current on living tissues has been used in to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa Objective: The goal of this study is to evaluate success of endoscopic techniques in treatment of Barrett’s esophagus and need for subsequent surgical intervention in patients with GERDcomplicated by Barrett's esophagus. Materials and methods: Patients with Barrett's esophagus C1-3M2-4 (Prague classification in 2004) and high dysplasia without nodules, as well as confirmed GERD without hiatal hernia were included. Endoscopic treatment was performed by argonoplasmic coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients re-examined. Patients with recurrence of metaplasia and high De Meester index (˃ 100) underwent antireflux surgery - crurography and Nissen fundoplication with a soft and short cuff. Results: A total of 89 patients were included in the study, of which 81 were reexamined after ablation of Barrett's esophagus. In 12 patients, a relapse of small bowel type metaplasia was recorded. Nine patients underwent two-stage treatment - first, a second session of ablation of the esophagus, and at the second stage, antireflux surgery. 3 patients refused surgical treatment and underwent only a second ablation session. All patients received drug therapy - prokinetics and proton pump inhibitors. 3 months after the operation, the pH metry was repeated, which showed the normalization of the De Meester index, and as a result, the patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus in accordance with the Seattle Protocol. After examining the histological material, no metaplasia zones were recorded. Conclusions: Antireflux surgery is required as part of the treatment of Barrett’s esophagus to prevent further dysplasia and development of esophageal cancer.