Impact of Laparoscopic Nissen Fundoplication on Non-complicated Barrett's Esophagus

Overview

Journal Saudi J Gastroenterol

Specialty Gastroenterology

Date 2011 May 7

PMID 21546721

Authors

Ashraf A Mohamed

Khaled M Mahran

Mohamed M Zaazou

Affiliations

Soon will be listed here.

Abstract

Background/aim: Laparoscopic fundoplication can alter the natural course of Barrett's esophagus (BE). This study was undertaken to assess this role in patients with non-complicated BE.

Materials And Methods: From October 2004 to October 2009, 43 patients with BE (32 men and 11 women) underwent laparoscopic Nissen fundoplication surgery in the Department of Surgery at Minia University Hospital. The median age of these patients was 46 years (range: 22-68 years). Patients with high-grade dysplasia, invasive cancer, or previous antireflux surgery were excluded. All 43 patients had gastroesophageal reflux symptoms. Heartburn was present in all patients, regurgitation in 41 (95.3%), dysphagia in 8 (18.6%), retrosternal pain in 30 (69.8%), upper gastrointestinal hemorrhage in 6 (13.9%), and respiratory symptoms in 19 (44.2%). Nissen fundoplication was performed in all patients. Thirty-four patients (79.1%) had concomitant hiatal hernia and nine patients (20.9%) had low-grade dysplasia.

Results: The median follow-up period was 25.6 months. There was significant improvement of symptoms after surgery (P<0.05). Eight (18.6%) of those with short-segment BE had total regression and four (9.3%) of those with long-segment BE had a decrease in total length. Among the nine patients with preoperative low-grade dysplasia, dysplasia disappeared in seven, remained unchanged in one, and progressed to in situ adenocarcinoma in one patient.

Conclusions: laparoscopic fundoplication succeeded in controlling symptoms but had unpredictable effect on dysplasia and regression of BE. Laparoscopic fundoplication does not eliminate the risk of developing esophageal adenocarcinoma and therefore, endoscopic follow-up should be continued in these patients.

References

Demeester S, DeMeester T . Columnar mucosa and intestinal metaplasia of the esophagus: fifty years of controversy. Ann Surg. 2000; 231(3):303-21. PMC: 1421001. DOI: 10.1097/00000658-200003000-00003. View

Oelschlager B, Barreca M, Chang L, Oleynikov D, Pellegrini C . Clinical and pathologic response of Barrett's esophagus to laparoscopic antireflux surgery. Ann Surg. 2003; 238(4):458-64. PMC: 1360106. DOI: 10.1097/01.sla.0000090443.97693.c3. View

NAEF A, Savary M, Ozzello L . Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas. J Thorac Cardiovasc Surg. 1975; 70(5):826-35. View

Starnes V, ADKINS R, Ballinger J, SAWYERS J . Barrett's esophagus. A surgical entity. Arch Surg. 1984; 119(5):563-7. DOI: 10.1001/archsurg.1984.01390170059012. View

Wang K, Sampliner R . Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008; 103(3):788-97. DOI: 10.1111/j.1572-0241.2008.01835.x. View

Desai K, Soper N, Frisella M, Quasebarth M, Dunnegan D, Brunt L . Efficacy of laparoscopic antireflux surgery in patients with Barrett's esophagus. Am J Surg. 2003; 186(6):652-9. DOI: 10.1016/j.amjsurg.2003.08.009. View

Eckardt V . Does healing of esophagitis improve esophageal motor function?. Dig Dis Sci. 1988; 33(2):161-5. DOI: 10.1007/BF01535727. View

Gotley D, Smithers B, Rhodes M, Menzies B, Branicki F, NATHANSON L . Laparoscopic Nissen fundoplication--200 consecutive cases. Gut. 1996; 38(4):487-91. PMC: 1383101. DOI: 10.1136/gut.38.4.487. View

DeMeester T, Attwood S, Smyrk T, Therkildsen D, Hinder R . Surgical therapy in Barrett's esophagus. Ann Surg. 1990; 212(4):528-40; discussion 540-2. PMC: 1358292. DOI: 10.1097/00000658-199010000-00015. View

10.

Mabrut J, Baulieux J, Adham M, de la Roche E, Gaudin J, Souquet J . Impact of antireflux operation on columnar-lined esophagus. J Am Coll Surg. 2003; 196(1):60-7. DOI: 10.1016/s1072-7515(02)01502-8. View

11.

Gurski R, Peters J, Hagen J, DeMeester S, Bremner C, Chandrasoma P . Barrett's esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg. 2003; 196(5):706-12; discussion 712-3. DOI: 10.1016/S1072-7515(03)00147-9. View

12.

Cowgill S, Al-Saadi S, Villadolid D, Zervos E, Rosemurgy 2nd A . Does Barrett's esophagus impact outcome after laparoscopic Nissen fundoplication?. Am J Surg. 2006; 192(5):622-6. DOI: 10.1016/j.amjsurg.2006.08.010. View

13.

Brand D, Ylvisaker J, Gelfand M, Pope 2nd C . Regression of columnar esophageal (Barrett's) epithelium after anti-reflux surgery. N Engl J Med. 1980; 302(15):844-8. DOI: 10.1056/NEJM198004103021506. View

14.

Hirota W, Loughney T, Lazas D, Maydonovitch C, Rholl V, Wong R . Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. Gastroenterology. 1999; 116(2):277-85. DOI: 10.1016/s0016-5085(99)70123-x. View

15.

Cameron A . Epidemiology of columnar-lined esophagus and adenocarcinoma. Gastroenterol Clin North Am. 1997; 26(3):487-94. DOI: 10.1016/s0889-8553(05)70308-3. View

16.

Bloomston M, Nields W, Rosemurgy A . Symptoms and antireflux medication use following laparoscopic Nissen fundoplication: outcome at 1 and 4 years. JSLS. 2003; 7(3):211-8. PMC: 3113200. View

17.

Farrell T, Smith C, Metreveli R, Johnson A, Galloway K, Hunter J . Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus. Am J Surg. 1999; 178(1):18-21. DOI: 10.1016/s0002-9610(99)00111-7. View

18.

Bloomston M, Zervos E, Gonzalez R, Albrink M, Rosemurgy A . Quality of life and antireflux medication use following laparoscopic Nissen fundoplication. Am Surg. 1998; 64(6):509-13; discussion 513-4. View

19.

WILLIAMSON W, ELLIS Jr F, GIBB S, Shahian D, Aretz H . Effect of antireflux operation on Barrett's mucosa. Ann Thorac Surg. 1990; 49(4):537-41; discussion 541-2. DOI: 10.1016/0003-4975(90)90298-k. View

20.

Hofstetter W, Peters J, DeMeester T, Hagen J, Demeester S, Crookes P . Long-term outcome of antireflux surgery in patients with Barrett's esophagus. Ann Surg. 2001; 234(4):532-8; discussion 538-9. PMC: 1422076. DOI: 10.1097/00000658-200110000-00012. View