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Long Follow-up in Patients With Barrett's Esophagus Submitted to Fundoplication. What Is the Importance of the Endoscopic Surveillance?
Sergio Szachnowicz*, Francisco C. Seguro, Rubens a. Sallum, Angela FalcãO, Julio R. Rocha, Ary Nasi, Ivan Cecconello
Department of Gastroenterology, Esophageal Surgical Division - University of Sao Paulo Medical School - Brazil, São Paulo, Brazil
Background: Barrett' s esophagus is associated to esophageal adenocarcinoma. Endoscopic surveillance of patients treated surgically or clinically allows early detection of cancer. Some authors concluded that surveillance is not cost-effective and does not reduce mortality from cancer.
Aim: We analyze efficacy of endoscopic surveillance in patients with Barrett's esophagus submitted to fundoplication.
Methods: from January 1980 to November 2012, 221 patients with Barrett's esophagus were submitted to fundoplication to control reflux. Of those, 196 were followed (mean 82 months) . All patients in our service had routine endoscopic examination each 2 years with multiple biopsies.
Results: Ten patients (8.9%) showed Barrett's endoscopic regression. Three patients (2.6%) were diagnosed with esophageal adenocarcinoma in this series. Two underwent prolonged pH monitoring that showed no acid reflux. They were asymptomatic and had diagnostic of early adenocarcinoma during routine endoscopy 2 (2) and 6 years after fundoplication. All underwent transhiatal esophagectomy and are alive (12 to 56 months).
Conclusion: Besides the related low cost-effectiveness of endoscopy surveillance, cancer was detected during follow up of Barrett's patients submitted to a successful antireflux procedure allowing early diagnosis and cure.
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