Barrett's Esophagus Does Not Adversely Affect Objective Results and Long-Term Clinical Outcome after Laparoscopic Antireflux Procedures
Abstracts
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Barrett's esophagus (BE) is present in 15-20% of patients with GERD, and is an expression of severe gastroesophageal disease. Because BE is more frequently associated with large hiatal hernias, periesophageal inflammation, and shortened esophagi, its presence may be a predictor of inferior outcomes after laparoscopic antireflux procedures (LAP). The aim of this study was to determine if BE adversely affects objective outcomes or long term symptom control after LAP. We prospectively collected data on 754 patients with GERD from 11/1993 to 11/2000 who subsequently underwent LAP, 115 (15%) of which had BE. A Nissen fundoplication was done in 714 (95%) and a Toupet fundoplication was done in 40 (5%) pts. 295/754 patients (39%) (53, 46% of the 115 with BE) had 24-hour pH monitoring between three to six months post-operatively. Long-term clinical follow-up was available for 113/115 (98%) patients with BE (mean f/u: 42.8 months, SD+/-23.3). After fundoplication distal esophageal acid exposure improved in all but 5 (90%) and returned to normal values in 36/48 (75%) of patients with BE while it was improved in 199/217 (92%) and became normal in 179 (83%) of non-BE patients in whom pre and postoperative data were available. Univariate analysis revealed no difference in the percentage of acid exposure in the distal esophagus three-six months after operation in patients with BE and in those without [OR: 1.1, 95%CI: 0.4-3.2]. Comparing clinical results at an average of 43 months postoperatively with preoperative symptoms, heartburn was improved in 108/113 (96%) and completely absent in 83 patients (74%). Similarly, regurgitation was better in 102/113 (90%), and dysphagia improved in 97 (86%). In conclusion excellent long-term control of symptoms is experienced by patients with BE after LAP. Moreover, equivalent objective control of gastroesophageal reflux may be obtained from fundoplication in patients with and without BE. |
