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 21 February 2018

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News

Response of Barrett's esophagus to laparoscopic antireflux surgery

In patients with Barrett's esophagus, laparoscopic antireflux surgery provides excellent control of symptoms and esophageal acid exposure, report investigators from the United States.

News image

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Patients with Barrett's esophagus (BE) are frequently offered laparoscopic antireflux surgery (LARS) to treat symptoms. However, the effectiveness of this operation is unclear.

In this study, investigators assessed 106 consecutive patients with BE who underwent LARS between 1994 and 2000.
Heartburn improved in 96% of patients.
Annals of Surgery

The team's findings are published in the October issue of the Annals of Surgery.

All patients were followed-up in 2002. The team performed a functional evaluation (manometry and 24-hour pH monitoring) in 50%, and endoscopy with appropriate biopsies in 85%.

The research team found that heartburn improved in 96% of patients and resolved in 70% following LARS.

Furthermore, regurgitation improved in 84% and dysphagia improved in 82%.

In addition, distal esophageal acid exposure improved in 91% of the patients tested, and returned to normal in 74%.

The team found that preoperative biopsies revealed BE without dysplasia in 91 patients, BE indefinite for dysplasia in 12 patients, and low-grade dysplasia in 3 patients. They also identified short-segment BE in 54 of the 90 patients with endoscopic follow-up, and long-segment BE in 36.

Postoperatively, the team found that intestinal metaplasia had completely regressed in 55% of the 54 patients with short-segment BE. In those patients with complete regression, 89% of those tested with pH monitoring had normal esophageal acid exposure.

The investigators observed normal esophageal acid exposure in only 69% of those who failed to have complete regression.

During the course of this study, 1 patient developed adenocarcinoma within 10 months of LARS.

Dr Brant Oelschlager's team concluded, "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".

Ann Surg 2003; 238(4): 458-66
09 October 2003

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