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Oesophageal I
PTU-167 The role of proton pump inhibitors in patients with Barrett's oesophagus following laparoscopic fundoplication can only be determined after the level of residual reflux has been quantified
  1. A Bond,
  2. D Wilson,
  3. A Hastings,
  4. F Rowley,
  5. D Veeramootoo,
  6. K K Singh
  1. Department of Surgery, Worthing Hospital, Worthing, UK

Abstract

Introduction Laparoscopic fundoplication is carried out for pathological Gastro Oesophageal Reflux in patients with and without Barrett's oesophagus. It has been suggested that in patients with Barrett's, only those patients with no physiological evidence of reflux post surgery have any reduction in risk of transition to cancer. The aim of this study is to quantify and compare residual reflux post fundoplication in patients with and without Barrett's Oesophagus.

Methods Data were collated from January 2002 to December 2011, using the hospital coding database for a single consultant surgeon. Each case was studied for patient demographics, indication, operative findings and outcomes. Prospectively collected data on pre and post operative pH manometry was assessed for evidence of reflux. Total percentage time less than pH 4 was used to determine reflux and a paired t-test was used to compare reflux between the groups.

Results 78 patients had a Nissen Fundoplication, 32 with Barrett's oesophagus. There was no significant difference between age and sex of the Barrett's and non Barrett's groups. There is seen to be a significant difference in reflux between the pre operative groups (p=0.0227) when looking at reflux, but a very significant difference (p=0.0038) when comparing reflux postoperatively between those with and those without Barrett's.

Conclusion There is a significantly higher level of residual reflux in patients with Barretts oesophagus following fundoplication even when patients report no symptoms. Therefore those with Barrett's should continue with Proton Pump Inhibitors until there is confirmed evidence of no reflux.

Competing interests None declared.

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