Clinical and histologic follow-up after antireflux surgery for Barrett’s esophagus |
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Authors: | Steven P Bowers MD Samer G Mattar MD C Daniel Smith MD J Patrick Waring MD John G Hunter MD |
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Institution: | (1) Department of Surgery, Emory University School of Medicine, Atlanta, Georgia;(2) Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;(3) Department of Surgery, Oregon Health Sciences University, Portland, Oregon;(4) 1364 Clifton Rd., Room H124, 30322 Atlanta, GA |
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Abstract: | There are few prospective studies that document the histologic follow-up after antireflux surgery in patients with Barrett’s
esophagus, as defined by the recently standardized criteria. We report the clinical, endoscopic, and histologic results of
patients with Barrett’s esophagus followed postoperatively for at least 2 years. Diagnosis of Barrett’s esophagus required
preoperative endoscopic evidence of columnarlined epithelium in the esophagus and a biopsy demonstrating specialized intestinal
metaplasia, which stains positively with Alcian blue stain. Between April 1993 and November 1998, a total of 104 patients
meeting these criteria underwent fundoplication (laparoscopic n = 84] or open n = 6] nissen, laparoscopic Toupet n = 11],
laparoscopic Collis-Nissen n = 1], Collins-Toupet n = 1] or open Dor n = 1]). Short-segment Barrett’s esophagus (length
of intestinal metaplasia <3 cm) was found preoperatively in 34% and low-grade dysplasia in 4% of patients. All patients were
contacted yearly by mail, phone, or clinic visit. At a mean follow-up of 4.6 years (range 2 to 7.5 years), 81% of patients
had stopped taking antisecretory medications and 97% were satisfied with the results of their operations. Eight patients have
undergone reoperation for recurrence of symptoms. Two patients have died and two were excluded from endoscopic biopsy because
of portal hypertension. Sixty-six patients complied with the surveillance protocol, and their histologic results were returned
to our center. Symptomatic follow-up of the 34 patients who refused surveillance esophagogastro and duodenoscopy revealed
two patients who were taking medication for reflux symptoms. None of the patients have developed high-grade dysplasia or esophageal
carcinoma during surveillance endoscopy (337 total patient-years of follow-up). The incidence of regression of intestinal
metaplasia to cardiac-fundic-type metaplasia after successful antireflux surgery is greater than previously reported. We suspect
that this is a result of longer follow-up and the inclusion of patients with short-segment Barrett’s esophagus. A substantial
number of patients with Barrett’s esophagus who are asymptomatic after antireflux surgery refuse surveillance endoscopy.
Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23,
2001 (oral presentation). |
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Keywords: | Barrett’ s esophagus antireflux surgery outcome regression |
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