Impact of antireflux surgery on Barrett's esophagus

Gutschow, Christian A.; Schröder, Wolfgang; Prenzel, Klaus L.; Bollschweiler, Elfriede; Romagnoli, Renato; Collard, Jean-Marie; Hölscher, A. H.

doi:10.1007/s00423-002-0303-0

Cited by 18 publications

(12 citation statements)

References 71 publications

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“…One important point in the discussion is the fact whether surgery prevents the development of ''de novo'' Barrett's esophagus in patients in whom no Barrett's esophagus was present at the time of initial surgery. Several authors, such as DeMeester [18], Theisen [19], Gutschow [20] and Wetscher [21], believe that this fact is exceedingly rare in patients who have an effective antireflux procedure, and postulate that no reports of BE that has developed following a successful antireflux operation have been published.…”

Section: Introductionmentioning

confidence: 98%

Barrett-Ösophagus nach Antireflux-Chirurgie

et al. 2008

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BACKGROUND: Surgical treatment in patients with gastroesophageal reflux disease (GERD) without Barrett's esophagus (BE) is an excellent alternative therapy to medical treatment, preventing the development of complications and the appearance of BE. PURPOSE: To determine the newly developed BE in a group of patients without BE prior to surgery, the patients were submitted to a late subjective and objective follow-up. METHODS: From 115 non-BE patients submitted to surgery and followed up for a long period, 12 (10.4%) developed intestinal metaplasia after operation. They were submitted to endoscopic, histologic, manometric and functional studies (24-h pH and Bilitec). RESULTS: The 12 patients had an average of 5 endoscopies after surgery with several biopsy samples. Symptoms of recurrent reflux were present in only 10 patients (83%) at a mean of 80 months after surgery. The mean follow-up was 135 months. Four patients showed the absence of pathologic reflux measured by 24-h pH and Bilitec monitoring, while 8 had the presence of abnormal acid reflux. There were no significant differences between endoscopic, histologic and functional studies comparing patients with the presence or absence of pathologic reflux. The time of appearance to intestinal metaplasia from cardiac or oxynto-Cardiac mucosa was 58-90 months. Four patients showed regression of intestinal metaplasia to cardiac mucosa after intensive medical treatment. CONCLUSIONS: Antireflux surgery in patients without BE does not prevent the late appearance of BE in near 10% of the cases, provided that a long-term follow-up is performed and several endoscopic and histologic evaluations are repeated. Near 2/3 of these patients showed the presence of acid reflux, while 1/3 showed no abnormal reflux. With this method of follow-up, metaplastic changes from cardiac to intestinal metaplasia and from intestinal metaplasia to low-grade dysplasia can be documented, as well as regression from intestinal metaplasia to cardiac mucosa

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Section: Introductionmentioning

confidence: 98%

Barrett-Ösophagus nach Antireflux-Chirurgie

et al. 2008

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“…Both concepts did not clearly show success in prospective randomized trials. Our own review of the literature showed a considerable number of adenocarcinomas after fundoplication and not only after failed antireflux procedures [30]. This result was confirmed by a metaanalysis in 2007 [31].…”

Section: Prevention By Antireflux Surgery or Medicationmentioning

confidence: 72%

Reflux esophagitis, high-grade neoplasia, and early Barrett’s carcinoma—what is the place of the Merendino procedure?

Hölscher

Vallböhmer

Gutschow

et al. 2008

Langenbecks Arch Surg

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“…found six cases of columnar metaplasia among 89 patients undergoing upper GI‐endoscopy 1–195 months after subtotal esophagectomy and gastric pull‐up 5 . Furthermore, the prevalence of BE in series of patients undergoing endoscopy for various indications or specific reflux symptoms was 1.75% and 11.2%, respectively, in a review of the literature from 1970 to 2000 6 . Patients with BE show a higher prevalence of incompetent lower esophageal sphincter (LES) on esophageal manometry than patients with uncomplicated GERD, 7 and it has been shown that the extent of BE correlates inversely with the resting pressure of the LES 8 .…”

Section: Role Of Gastroesophageal Reflux Disease In the Pathogenesis mentioning

confidence: 99%