Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus

Abstract

HALO RFA is a safe procedure, with high rate of success in complete eradication of BE in symptomatic GERD patients. LNF provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first line of treatment after HALO RFA.

Alternative therapies for GERD: a way to personalized antireflux surgery

“…One of the studies revealed that patients with IM and dysplastic BE who were submitted to ARS after RFA have statistically lower incidence of persistent and recurrent BE opposed to those receiving PPI's on a 1‐year follow‐up . In another study, which prospectively evaluated BE recurrence after RFA, ARS proved to be superior over the PPI regimen in patients with long BE (≥4 cm), with significantly lower incidence on a 3‐year follow‐up . Recent data that covered a 5‐year follow‐up of patients included in randomized Ablation of Intestinal Metaplasia Containing Dysplasia trial (AIM Dysplasia Trial) pointed out that recurrence of BE is most frequent in the first year following RFA .…”

“…In this manner, after the hiatal hernia is reduced, esophagus encircled and pulled into the abdomen, esophageal lumen is narrowed, so that RFA electrodes apply more closely to the mucosa. Concomitant ARS and RFA was proven to be safe, not time‐consuming, and it was performed in conjunction with the basic rules of RFA procedure, avoiding potential pitfall of choosing wrong balloon diameter . To conclude, ARS as the addition to RFA of BE may play an important role in recurrence prevention, which, however, has to be demonstrated in sufficiently powered studies.…”

“…14 In another study, which prospectively evaluated BE recurrence after RFA, ARS proved to be superior over the PPI regimen in patients with long BE (ࣙ4 cm), with significantly lower incidence on a 3-year followup. 15 Recent data that covered a 5-year followup of patients included in randomized Ablation of Intestinal Metaplasia Containing Dysplasia trial (AIM Dysplasia Trial) pointed out that recurrence of BE is most frequent in the first year following RFA. 16 Concerning the data available so far, we have to think of optimal prevention strategy in the early follow-up period and consider the ARS in selected group of patients.…”

Barrett's esophagus: diagnosis and management

“…There is some evidence that post-ablation the neosquamous epithelium is potentially more prone to reflux injury [145], possibly increasing the risk of BE recurrence. A recent study found decreased BE recurrence after RFA with Nissen fundoplication versus PPI therapy, in the subgroup of patients with long-segment BE and a hiatal hernia >3 cm [146]. However, current data as to any incremental benefit of a surgical anti-reflux procedure compared with medical therapy after successful RFA remains inconclusive [147, 148], and in general the indications for consideration of fundoplication after RFA remain similar to those in the general GERD population.…”

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

“…There are literature reports justifying laparoscopic antireflux surgery after radiofrequency ablation of Barrett's esophagus (BE), as it has been proven that the addition of fundoplication may result in less persistent or recurrent BE, especially in patients with longer BE segments and a hiatal hernia of > 3 cm [12,13]. Future studies in this direction are certainly warranted.…”