The treatment of choice in Barrett’s esophagus (BE) is still controversial.
Some clinical studies suggest that surgery could be more effective than medical treatment in preventing BE from progressing to dysplasia and adenocarcinoma.
However, data from prospective comparative studies are necessary to answer this question.
In this study, researchers from Spain compared the results of medical treatment and antireflux surgery in patients with Barrett's esophagus.
The research team included 101 patients in this randomized prospective study. Of these, 43 received medical treatment and 58 antireflux surgery.
All patients underwent clinical, endoscopic, and histologic assessment.
|Satisfactory clinical results were achieved in 91% of patients in both treatment groups.|
|Annals of Surgery|
Additionally, functional studies were performed in all the operated patients, and in a subgroup of patients receiving medical treatment.
Median follow-up was 5 years in the medical treatment group and 6 years in the surgical treatment group.
The team found that satisfactory clinical results were achieved in 91% of patients in both treatment groups.
However, the persistence of added inflammatory lesions was significantly higher in the medical treatment group.
The metaplastic segment did not disappear in any case.
Postoperative functional studies showed a significant decrease in the median percentage of total time with pH below 4. However, the team found that 15% of patients in the surgery group showed pathologic rates of acid reflux.
They also determined that high-grade dysplasia appeared in 5% of the medical treatment group and 3% in the surgical treatment group. In the latter, both patients presented with clinical and pH-metric recurrence.
There was no case of malignancy after successful antireflux surgery.
Dr Pascual Parrilla’s team concluded, “These results show that there are no differences between the 2 types of treatment with respect to preventing BE from progressing to dysplasia and adenocarcinoma”.
“However, successful antireflux surgery proved to be more efficient than medical treatment in this sense, perhaps because it completely controls acid and biliopancreatic reflux to the esophagus.”