2005 Abstracts: Outcome of Laparoscopic Antireflux Surgery for Barrett's Esophagus
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Outcome of Laparoscopic Antireflux Surgery for Barrett's Esophagus
Suad A. Gholoum, McGill University, Montreal, Quebec, Canada; Serge Mayrand, McGill University Health Centre, Montreal, Quebec, Canada; Victoria Marcus, Liane S. Feldman, McGill University, Montreal, Quebec, Canada; Donna D. Stanbridge, McGill University Health Centre, Montreal, Quebec, Canada; Gerald M. Fried, McGill University, Montreal, Quebec, Canada
Laparoscopic antireflux surgery (LARS) is now considered the treatment of choice for symptomatic gastroesophageal reflux disease (GERD), but its effectiveness and durability for patients with Barrett's metaplasia has been questioned. The aim of this study is to evaluate the outcome of LARS for Barrett's esophagus after 3-year follow-up.
Methods: 116 consecutive GERD patients were studied prospectively from 1995- 2004. All underwent laparoscopic fundoplication (113 Nissen, 3 Toupet); 30 pts had Barrett's preoperatively. Patients were assessed preop and serially after surgery by Velanovich GERD quality of life (QOL) score, SF12 generic QOL score, endoscopy + biopsy, and satisfaction score. Manometry and 24hr pH tests were done preop, 3 mo postop and repeated if indicated. Regression of Barrett's was defined as two consecutive biopsies showing no metaplasia, reviewed by 2 pathologists. Data were analyzed using Wilcoxon signed rank test or paired t-test. Differences of P<0.01 were significant. Results: Barrett's patients (21 male, 9 female) had median age 44 (19-69), mean BMI 28.4, and had symptoms for 6 yr (1-25) preop; 3 patients had preop dysplasia. Follow-up was 36 months median (3-96 mo). The Velanovich score improved from 18+/-8 to 5+/-6, time pH < 4 improved from 22+/-16 to 2.5 +/-6, % patients with abnormal pH tests decreased from 93% to 11%, satisfaction improved from mean score of 4 +/-5 to 1 +/5, and LES pressure increased from 8+/-6 to 18+/-6. All differences were significant (p<0.01). SF12 was normal preop and did not change after surgery. Anatomic failure (development of hiatal hernia) occurred in 1 patient postop. Endoscopic biopsy documented reversal of metaplasia in 20%. Endoscopic esophagitis was present in 74% preop and 6.6% at most recent biopsy. Overall, the results of surgery for the Barrett's group did not differ from the group without Barrett's. Conclusions: In patients with Barrett's metaplasia followed for 3 years, laparoscopic antireflux surgery controls acid reflux, improves symptoms and patient satisfaction, and results in control of esophagitis. A minority of patients (20%) will show regression of Barrett's. Continued long-term follow-up is required to assess durability of these benefits.
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