Anti-reflux Surgery Is Not Totally Effective Against Esophageal Adenocarcinoma, Despite the Regression or Disappearance of Barrett’s Esophagus in Most Cases – A Study of 80 Barret’s Patients.

BACKGROUND: Barrett’s Esophagus (BE) is a complication of gastroesophageal reflux disease (GERD) and can be a pre-malignant condition. laparascopic anti-reflux surgeries (LARS) significantly correct physiological and anatomical abnormalities in patients with GERD; nevertheless, there is no consensus about its effectiveness in preventing malignant transformation in patients with BE. The impact of LARS on those suffering from BE and in particular its effect not only on the regression of metaplasia but also on the progression of metaplasia and dysplasia toward adenocarcinoma is still not understood.
AIM: The objective of this study is to prospectively evaluate clinical, endoscopic and histopathological results after Laparoscopic Nissen Fundoplication (LapNissen) in patients suffering from BE.
METHOD: From January 2000 to August 2007, 315 patients suffering from GERD underwent LapNissen performed by the same surgeon. Of these 80 (25.39%) had BE. There were no conversions to open surgery and all patients were discharged within 48 hours. Follow-up using endoscopic biopsy was performed in all 80 patients. Average follow-up was 46.8 months.
RESULTS: The control of symptoms was effective in 77 patients. Three patients remained symptomatic and used a proton pump inhibitor. BE therefore remained unaltered in these patients. Regression of BE occurred in 49 (61.25%) patients. Of these 24 (30%) showed no further signs of BE in endoscopic or histopathological examinations. In one patient, who remained asymptomatic after surgery, the degree of dysplasia increased to high-grade dysplasia and another asymptomatic patient developed adenocarcinoma. Both underwent endoscopic mucosectomy of the BE area. No-one died or suffered any significant secondary complications after surgery.
CONCLUSIONS: LapNissen is safe and effective in the control of symptoms in a significant number of patients with BE. In spite of regression occurring at a randomly high percentage level in patients operated and the control of GERD attained by most patients, the development of high-grade dysplasia and adenocarcinoma is not fully prevented by Anti Reflux Surgery. Routine endoscopy follow up with biopsy is highly recommended for all patients with BE after LARS.

Session: Podium Presentation

Program Number: S001