Abstracts
2000 Digestive Disease Week

# 2253 What Is the Clinical Significance of Esophageal Histology After Antireflux Surgery?
Jarmo A. Salo, Tuomo K Rantanen, Judith Makinen, Pentti Sipponen, Tuula Kiviluoto, Juhani O. Ramo, Espoo, Finland, Helsinki, Finland, Vantaa, Finland

The laparoscopic technique has increased the number of antireflux operations and postoperative esophagoscopies including biopsies. However, there is only limited and controversial information about the effect of successful fundoplication on esophageal mucosal histology and its clinical significance. 40 patients with gastroesophageal reflux disease (GERD) without Barrettīs metaplasia (pH < 4, mean 13.3% in 24 hour pH monitoring) had fundoplication. Healing of GERD was verified by endoscopy (normal mucosa and intact wrap), normal 24 hour pH monitoring (pH < 4, mean 1.13%) and normal LES pressure (mean 19 mmHg). 97 pre- and 94 postoperative biopsies from macroscopic lesions or 3-5 cm above the esophagogastric junction were randomly examined by two blinded experienced histopathologists (Hpath I/Hpath II) without knowing the clinical situation or the timing of the biopsies. In addition, inter- and intraobserver variation was determined. 32/31 patients (Hpath I/Hpath II) had adequate biopsies for both pre- and postoperative histological analysis according to Richardson et al (1). Hpath I: Postoperative biopsies: 69% normal, 22% mild, 3% moderate and 6% severe histological changes of reflux esophagitis, not significantly different from preoperative findings. Changes improved in 44% of patients, remained unchanged in 31% and progressed in 25%. Hpath II: Postoperatively 77% normal biopsies (p = 0.001), 3% mild (p = 0.003), 13% moderate and 7% severe histological changes. Histological changes improved in 45% of patients, remained unchanged in 39% and progressed in 16%. Both pathologists interpreted 61% postoperative biopsies to normal (p = 0.010) when compared to preoperative, 0% to mild, 3% to moderate and 6.5% to severe changes. Histological changes improved in 11 patients (35.5%). Among Hpath I (90.6%) and Hpath II (81%) the disappearing of esophageal mucosal inflammation correlated best to normalized pH monitoring. In preoperative biopsies inter- and intraobserver variation were 33.8% and 9.7%, and in postoperative biopsies 21.1% and 5.6%. Despite of healing of GERD after successful antireflux surgery the esophageal histology remains confusing. The clinical impact of routine esophageal histology after successful fundoplication is limited if other findings such as endoscopic finding including fundic wrap and 24 hour pH monitoring are normal. Reference: 1) Richardson J,Kuhns J, Richardson R, Polk H Jr. Properly conducted fundoplication reverses histologic evidence of esophagitis. Ann Surg 1983;6:763-769.