Long-term Follow up after Laparoscopic Anti-reflux Surgery in patients with Barrett’s Esophagus

Ellen H Morrow, MD, Daniel Bushyhead, BA, Eelco Wassenaar, MD, Marcelo Hinojosa, MD, Maximiliano Loviscek, MD, Carlos Pellegrini, MD, Brant Oelschlager, MD. University of Washington.

Introduction
     Barrett’s esophagus (BE) is caused by chronic gastro-esophageal reflux disease (GERD). It is hypothesized that laparoscopic anti-reflux surgery (LARS) may change the natural course of BE. The purpose of this study is to determine the long-term outcome of LARS in patients with BE.

Methods
     We analyzed the records of patients with BE who underwent LARS and who had post-operative histological follow-up ≥3 years with special attention to endoscopy findings, histology, and pH studies. Post-operative GERD symptoms were evaluated via questionnaire. Histological regression was defined as either loss of dysplasia or BE returning to squamous mucosa. Progression was defined as development of new dysplasia or adenocarcinoma.

Results
     Eighty-two patients met the inclusion criteria with a median histological follow-up time of 8 years (range: 3-16 years). Sixty-seven (82%) patients completed the post-operative questionnaire; 86% of patients reported durable improvement in heartburn and regurgitation, and 79% of patients reported improvement in aspiration. Thirty-four (41%) patients underwent pre- and post-operative dual probe pH studies. The median DeMeester score decreased from 54 to 9 (P=0.00).
     Histological regression of BE occurred in 19 (23%) patients. Three went from dysplasia to non-dysplastic metaplasia, and 16 from metaplasia to normal squamous epithelium. Normalization of acid exposure and short segment Barrett’s (3cm or less) were more common in the group with histological regression.
     Six patients (7%) had evidence of progression; one to LGD, 4 to HGD, and 1 to invasive adenocarcinoma.

Conclusions
     LARS was associated with both physiologic and symptomatic control of GERD in the majority of patients with BE.  Patients with LARS may experience histological regression of BE, which is more common in patients with short-segment Barrett’s and normalization of acid exposure.  Progression can also occur after LARS, and thus continued surveillance is indicated.

 

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