Original article: general thoracicBarrett's esophagus: the role of laparoscopic fundoplication
Section snippets
Material and methods
Between January 1995 through December 2000, 82 patients with BE underwent a surgical antireflux procedure at the Mayo Clinic in Rochester, Minnesota. A laparoscopic procedure was performed in 49 of these patients and they form the basis of this report. Our surgical technique for laparoscopic antireflux procedure (LARP) has been previously described 1, 2.
The records of these patients were retrospectively analyzed for age, gender, symptoms, diagnostic evaluation, indications for operation,
Results
The patients were composed of 35 men and 14 women. Median age at the time of LARP was 54 years (range, 28 to 85 years). All patients were symptomatic and included heartburn in 41 (84%), dysphagia in 16 (33%), epigastric or chest pain in 9 (18%), and other symptoms in 16 (33%). No patient had previous antireflux surgery.
All patients underwent preoperative esophagogastroduodenoscopy and all had biopsy proven BE. The BE was circumferential in 28 patients (57%) and patchy in 21 (43%). The median
Comment
Barrett's esophagus is the condition in which columnar epithelium replaces the squamous epithelium that normally lines the distal esophagus. This condition develops as a result of reflux of gastric, biliary, and pancreatic fluids into the esophagus, which eventually damages the squamous epithelium. Subsequent healing occurs through a metaplastic process in which columnar cells replace squamous ones, with the end-result that this specialized intestinal metaplasia predisposes patients to
References (28)
- et al.
Early experience and learning curve associated with laparoscopic Nissen fundoplication
J Thorac Cardiovasc Surg
(1998) - et al.
Laparoscopic repair of large paraesophageal hiatal hernia
Ann Thorac Surg
(2001) Antireflux surgery in the management of Barrett's esophagus
J Gastrointest Surg
(2000)- et al.
Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett's esophagus
Am J Gastroenterol
(1998) - et al.
Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus
Am J Surg
(1999) Antireflux surgery and adenocarcinoma of the esophaguslet the truth be told
Gastroenterology
(2001)- et al.
Rationale for surgical therapy of Barrett's esophagus
Mayo Clin Proc
(2001) - et al.
Impact of antireflux operation on columnar-lined esophagus
J Am Coll Surg
(2003) - et al.
Long-term results after reoperation for failed antireflux procedures
J Thorac Cardiovasc Surg
(1997) - et al.
Columnar-lined lower esophagusan acquired lesion with malignant predisposition: report on 140 cases of Barrett's esophagus with 12 adenocarcinomas
J Thorac Cardiovasc Surg
(1975)
Risk of adenocarcinoma of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery
Gastroenterology
Long-term survival after esophagectomy for Barrett's adenocarcinoma in endoscopically surveyed and nonsurveyed patients
J Gastrointest Surg
Surveillance and survival in Barrett's adenocarcinomaa population-based study
Gastroenterology
Management's of Barrett's esophagus with high-grade dysplasia
Surg Clin North Am
Cited by (59)
Esophagus and Gastrointestinal Junction Tumors
2020, Surgical Clinics of North AmericaCitation Excerpt :According to the Society of American Gastrointestinal Endoscopic Surgery (SAGES), surveillance for BE does not change after antireflux surgery. There is no evidence to suggest that surveillance is more challenging or less effective after antireflux surgery.51–53 Appropriate management of superficial carcinoma requires an accurate diagnosis of the extent of disease.
Esophageal body motility disorders
2019, Clinical and Basic Neurogastroenterology and MotilityAcid suppression and surgical therapy for Barrett's oesophagus
2015, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Earlier referral to surgical therapy may therefore be important to improve the changes of a successful outcome. Several surgical series have suggested that laparoscopic fundoplication can promote regression of BO and prevent progression to dysplasia without PPI treatment [56–69]. The published studies show almost uniformly a low incidence of progression to HGD or OAC after fundoplication.
Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: A systematic review and meta-analysis
2014, Gastrointestinal EndoscopyThe Mexican consensus on gastroesophageal reflux disease. Part II
2013, Revista de Gastroenterologia de MexicoDiagnosis and Surveillance of Barrett's Esophagus
2011, Clinical Gastrointestinal Endoscopy, Second Edition