Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery

Brant K. Oelschlager, Marc Barreca, Lilly Chang, Dmitry Oleynikov, Carlos A. Pellegrini, John Hunter, Tom R. DeMeester

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Abstract

Summary Background Data: Patients with Barrett's esophagus (BE) are frequently offered laparoscopic antireflux surgery (LARS) to treat symptoms. The effectiveness of this operation with regards to symptoms and to the evolution of the columnar-lined epithelium remains controversial. Methods: We analyzed the course of 106 consecutive patients with BE who underwent LARS between 1994 and 2000, representing 14% of all LARS (754) performed in our institution during that period. All 106 patients agreed to clinical follow-up in 2002 at 40 months (median; range, 12-95 months). Fifty-three patients (50%) agreed to functional evaluation (manometry and 24-hour pH monitoring); 90 patients (85%) to thorough endoscopy, with appropriate biopsies and histologic evaluation to determine the status of BE. Results: Heartburn improved in 94 (96%) of 98 and resolved in 69 patients (70%) after LARS. Regurgitation improved in 58 (84%) of 69 and dysphagia improved in 27 (82%) of 33. Distal esophageal acid exposure improved in 48 (91%) of 53 patients tested and returned to normal in 39 patients (74%). One patient underwent reoperation 2 days after fundoplication (gastric perforation). Preoperatively, biopsy revealed BE without dysplasia in 91 patients, BE indefinite for dysplasia in 12 patients, and low-grade dysplasia in 3 patients. Fifty-four of the 90 patients with endoscopic follow-up had short-segment BE (3cm) preoperatively. Postoperatively, endoscopy and pathology revealed complete regression of intestinal metaplasia (absence of any sign suggestive of BE) in 30 (55%) of 54 patients with short-segment BE but in 0 of 36 of those with long-segment BE. Among patients with complete regression, 89% of those tested with pH monitoring had normal esophageal acid exposure. This was observed in 69% of those who failed to have complete regression. One patient developed adenocarcinoma within 10 months of LARS. Conclusions: In patients with BE, LARS provides excellent control of symptoms and esophageal acid exposure. Moreover, intestinal metaplasia regressed in the majority of patients who had short-segment BE and normal pH monitoring following LARS, a fact that was, heretofore, not appreciated. LARS should be recommended to patients with BE to quell symptoms and to prevent the development of cancer.

Original languageEnglish (US)
Pages (from-to)458-466
Number of pages9
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Barrett Esophagus
Laparoscopy
Metaplasia
Endoscopy
Acids
Biopsy
Heartburn
Fundoplication

ASJC Scopus subject areas

  • Surgery

Cite this

Oelschlager, B. K., Barreca, M., Chang, L., Oleynikov, D., Pellegrini, C. A., Hunter, J., & DeMeester, T. R. (2003). Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery. Annals of Surgery, 238(4), 458-466.

Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery. / Oelschlager, Brant K.; Barreca, Marc; Chang, Lilly; Oleynikov, Dmitry; Pellegrini, Carlos A.; Hunter, John; DeMeester, Tom R.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 458-466.

Research output: Contribution to journalArticle

Oelschlager, BK, Barreca, M, Chang, L, Oleynikov, D, Pellegrini, CA, Hunter, J & DeMeester, TR 2003, 'Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery', Annals of Surgery, vol. 238, no. 4, pp. 458-466.
Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA, Hunter J et al. Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery. Annals of Surgery. 2003 Oct;238(4):458-466.
Oelschlager, Brant K. ; Barreca, Marc ; Chang, Lilly ; Oleynikov, Dmitry ; Pellegrini, Carlos A. ; Hunter, John ; DeMeester, Tom R. / Clinical and Pathologic Response of Barrett's Esophagus to Laparoscopic Antireflux Surgery. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 458-466.
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abstract = "Summary Background Data: Patients with Barrett's esophagus (BE) are frequently offered laparoscopic antireflux surgery (LARS) to treat symptoms. The effectiveness of this operation with regards to symptoms and to the evolution of the columnar-lined epithelium remains controversial. Methods: We analyzed the course of 106 consecutive patients with BE who underwent LARS between 1994 and 2000, representing 14{\%} of all LARS (754) performed in our institution during that period. All 106 patients agreed to clinical follow-up in 2002 at 40 months (median; range, 12-95 months). Fifty-three patients (50{\%}) agreed to functional evaluation (manometry and 24-hour pH monitoring); 90 patients (85{\%}) to thorough endoscopy, with appropriate biopsies and histologic evaluation to determine the status of BE. Results: Heartburn improved in 94 (96{\%}) of 98 and resolved in 69 patients (70{\%}) after LARS. Regurgitation improved in 58 (84{\%}) of 69 and dysphagia improved in 27 (82{\%}) of 33. Distal esophageal acid exposure improved in 48 (91{\%}) of 53 patients tested and returned to normal in 39 patients (74{\%}). One patient underwent reoperation 2 days after fundoplication (gastric perforation). Preoperatively, biopsy revealed BE without dysplasia in 91 patients, BE indefinite for dysplasia in 12 patients, and low-grade dysplasia in 3 patients. Fifty-four of the 90 patients with endoscopic follow-up had short-segment BE (3cm) preoperatively. Postoperatively, endoscopy and pathology revealed complete regression of intestinal metaplasia (absence of any sign suggestive of BE) in 30 (55{\%}) of 54 patients with short-segment BE but in 0 of 36 of those with long-segment BE. Among patients with complete regression, 89{\%} of those tested with pH monitoring had normal esophageal acid exposure. This was observed in 69{\%} of those who failed to have complete regression. One patient developed adenocarcinoma within 10 months of LARS. Conclusions: In patients with BE, LARS provides excellent control of symptoms and esophageal acid exposure. Moreover, intestinal metaplasia regressed in the majority of patients who had short-segment BE and normal pH monitoring following LARS, a fact that was, heretofore, not appreciated. LARS should be recommended to patients with BE to quell symptoms and to prevent the development of cancer.",
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AU - Oelschlager, Brant K.

AU - Barreca, Marc

AU - Chang, Lilly

AU - Oleynikov, Dmitry

AU - Pellegrini, Carlos A.

AU - Hunter, John

AU - DeMeester, Tom R.

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N2 - Summary Background Data: Patients with Barrett's esophagus (BE) are frequently offered laparoscopic antireflux surgery (LARS) to treat symptoms. The effectiveness of this operation with regards to symptoms and to the evolution of the columnar-lined epithelium remains controversial. Methods: We analyzed the course of 106 consecutive patients with BE who underwent LARS between 1994 and 2000, representing 14% of all LARS (754) performed in our institution during that period. All 106 patients agreed to clinical follow-up in 2002 at 40 months (median; range, 12-95 months). Fifty-three patients (50%) agreed to functional evaluation (manometry and 24-hour pH monitoring); 90 patients (85%) to thorough endoscopy, with appropriate biopsies and histologic evaluation to determine the status of BE. Results: Heartburn improved in 94 (96%) of 98 and resolved in 69 patients (70%) after LARS. Regurgitation improved in 58 (84%) of 69 and dysphagia improved in 27 (82%) of 33. Distal esophageal acid exposure improved in 48 (91%) of 53 patients tested and returned to normal in 39 patients (74%). One patient underwent reoperation 2 days after fundoplication (gastric perforation). Preoperatively, biopsy revealed BE without dysplasia in 91 patients, BE indefinite for dysplasia in 12 patients, and low-grade dysplasia in 3 patients. Fifty-four of the 90 patients with endoscopic follow-up had short-segment BE (3cm) preoperatively. Postoperatively, endoscopy and pathology revealed complete regression of intestinal metaplasia (absence of any sign suggestive of BE) in 30 (55%) of 54 patients with short-segment BE but in 0 of 36 of those with long-segment BE. Among patients with complete regression, 89% of those tested with pH monitoring had normal esophageal acid exposure. This was observed in 69% of those who failed to have complete regression. One patient developed adenocarcinoma within 10 months of LARS. Conclusions: In patients with BE, LARS provides excellent control of symptoms and esophageal acid exposure. Moreover, intestinal metaplasia regressed in the majority of patients who had short-segment BE and normal pH monitoring following LARS, a fact that was, heretofore, not appreciated. LARS should be recommended to patients with BE to quell symptoms and to prevent the development of cancer.

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