Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery

Oelschlager, Brant K.; Barreca, Marco; Chang, L.; Oleynikov, Dmitry; Pellegrini, Carlos A.; Hunter, RW; DeMeester, Tom R.

doi:10.1097/01.sla.0000090443.97693.c3

Cited by 117 publications

(72 citation statements)

References 34 publications

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“…In particular, the surgical therapy is helpful in allowing the majority of patients suffering from GERD to discontinue acid suppression therapy, to achieve resolution of associated esophagitis, and to arrest or perhaps even reverse the metaplasia/dysplasia induced by frequent exposure of the esophageal mucosa to gastric contents [Oelschlager et al 2003;Parise et al 2011;Rossi et al 2006].…”

Section: Surgical Therapymentioning

confidence: 99%

Optimal treatment of laryngopharyngeal reflux disease

Martinucci

Bortoli

Savarino

et al. 2013

Therapeutic Advances in Chronic Disease

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Laryngopharyngeal reflux is defined as the reflux of gastric content into larynx and pharynx. A large number of data suggest the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease. However, laryngopharyngeal reflux is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved in its pathogenesis. Current critical issues in diagnosing laryngopharyngeal reflux are many nonspecific laryngeal symptoms and signs, and poor sensitivity and specificity of all currently available diagnostic tests. Although it is a pragmatic clinical strategy to start with empiric trials of proton pump inhibitors, many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy. Overall, there are scant conflicting results to assess the effect of reflux treatments (including dietary and lifestyle modification, medical treatment, antireflux surgery) on laryngopharyngeal reflux. The present review is aimed at critically discussing the current treatment options in patients with laryngopharyngeal reflux, and provides a perspective on the development of new therapies.

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Section: Surgical Therapymentioning

confidence: 99%

Optimal treatment of laryngopharyngeal reflux disease

Martinucci

Bortoli

Savarino

et al. 2013

Therapeutic Advances in Chronic Disease

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“…After laparoscopic fundoplication, anatomic alterations of the EGJ are observed in 2% in non-Barrett's esophagus patients versus 16% in patients with Barrett's esophagus. [19][20][21][22][23][24][25][26][27][28] Martínez de Haro et al, 29 in 51 patients with reflux esophagitis followed for more than 6 years, obtained good results in 89% of patients, but endoscopic recurrence was higher (14%) and pathologic acid reflux confirmed by 24-hour pH monitoring was 20% after surgery. In Barrett's esophagus patients, the results are even worse.…”

Section: Discussionmentioning

confidence: 99%

“…There are many reports that confirm the safety of laparoscopic antireflux surgery for patients undergoing primary repair in hands of experienced surgeons. [16][17][18][19][20][21][22] However, there are several citations in the literature reporting failure rates of laparoscopic fundoplication from 2% to 17%. [22][23][24][25][26][27][28] These lower published rates probably reflect shorter follow-up rather than an intrinsically better operation.…”

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confidence: 99%

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

Braghetto

Korn

Csendes

et al. 2012

International Surgery

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After antireflux surgery for gastroesophageal reflux disease, 10% to 15% of patients may have unsuccessful results as a result of abnormal restoration of the esophagogastric junction. The purpose of this study was to evaluate the postoperative endoscopic and radiologic characteristics of the antireflux barrier and their correlation with the postoperative results. After surgery, endoscopic and radiologic features of the antireflux wrap were evaluated in 120 consecutive patients. Jobe's classification of the postoperative valve was used for the definition of a ''normal'' or ''defective'' wrap. Patients were evaluated 3 to 5 years later in order to determine the clinical and objective failed fundoplication. A ''normal'' antireflux wrap was associated with successful results in 81.7% of the patients. On the contrary, defective radiologic or endoscopic antireflux wrap was observed in 19% of cases. Among these patients, hypotensive lower esophageal sphincter was observed in 50% to 65% of patients, abnormal 24-hour pH monitoring in 91%, and recurrent postoperative erosive esophagitis in 50% of patients, respectively (P , 0.001). ''Defective'' antireflux fundoplication is associated with recurrent reflux symptoms, presence of endoscopic esophagitis, hypotensive lower esophageal sphincter, and abnormal acid reflux.Key words: Antireflux surgery -Postoperative failures -Defective fundoplication P atients with gastroesophageal reflux disease (GERD) have anatomic defects of the esophagogastric junction (EGJ) as dilatation of the cardia and/or presence of hiatal hernia. [1][2][3][4] These defects have been associated with incompetence of the lower esophageal sphincter (LES) and pathologic acid reflux. The aim of antireflux surgery is to create an antireflux barrier by increasing the competence of the LES and to avoid this abnormal acid reflux. However, failure of antireflux surgery has been reported in several publications and pathologic acid reflux test can be observed in 5% to 15% of GERD patients. 5,6 Zaninotto et al 6 reported 13.2% of reflux recurrence in patients with GERD (6.2% in patients with grade 0 to I esophagitis and 7% in patients with grade-II esophagitis, respectively). Presence of abnormal acid reflux has been reported after Nissen fundoplication as well as after Toupet or cardial calibration in a very similar percentage of cases. 7-9The restoration of the cardial anatomic integrity is followed by a successful outcome after surgery. On the contrary, some authors have published endoscopic or radiologic failures after fundoplication, with defective antireflux wrap associated with a high rate of symptomatic and objective reflux recurrence reaching up to 25% of cases. 2,10The purpose of this prospective study was to correlate the presence of postoperative radiologic and endoscopic defects of the new antireflux barrier after surgery and its association with persistence of symptoms, endoscopic esophagitis, hypotensive LES, and abnormal 24-hour pH monitoring. Patients and Methods Patients studiedIn this prospective ...

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“…La cirugía antirrefl ujo en EB también logra la regresión de la metaplasia intestinal, pero no en las proporciones a las obtenidas por nuestro estudio 19,20 . Otros mecanismos fi siopatológicos que explicarían nuestros resultados y las diferencias con la cirugía antirrefl ujo, es que el bypass gástrico es una técnica signifi cativa para la reducción de peso.…”

Section: Descripción De Nuevos Mecanismos Fi Siopatológicosunclassified

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

et al. 2012

Rev Chil Cir

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Effects of gastric bypass for morbid obesity on Barrett esophagusBackground: Besides the weight reducing effects of gastric bypass, it is also a good antirefl ux procedure since there is no acid production by the gastric pouch and there is no duodenal refl ux due to the presence of a Roux en Y. Aim: To describe the effect of gastric bypass on Barrett esophagus among patients with morbid obesity. Material and Methods: Among 896 patients subjected to gastric bypass, 14 patient with a Barrett esophagus diagnosed with endoscopy and biopsy, were followed. A new endoscopy was performed one to 30 months after the surgical procedure. Results: Short (< = 30 mm) and long segment (> = 31 mm) Barrett esophagi were present in eight and six patients, respectively. Gastroesophageal refl ux symptoms relieved in 70% of these cases in a mean lapse of 6.5 months. There was regression from intestinal metaplasia to cardial mucosa in six patients (75%) with short-segment, and in one patient (16%) with long-segment Barrett esophagus. Conclusions: Gastric bypass in patients with morbid obesity and Barrett esophagus is a very good antirefl ux operation. This was proved by the disappearance of symptoms in almost all patients and by the regression of the intestinal metaplasia which is time and length dependent.

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Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery

Cited by 117 publications

References 34 publications

Optimal treatment of laryngopharyngeal reflux disease

Optimal treatment of laryngopharyngeal reflux disease

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

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