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Is Early Fundoplication Associated With Increased RATES of Regression of Barrett's Esophagus?
Alfonso Arias GutiéRrez*, Beatriz De Rienzo, Estibalitz Laresgoiti-Servitje, Wolfgang Gaertner
centro medico ABC, Mexico city, Mexico
OBJECTIVE: The impact of antireflux surgery on Barrett's esophagus, in particular its effect on both regression and progression of metaplasia, remains unclear. Our aim was to review the outcomes of patients with Barrett's esophagus after Nissen fundoplication, and identify factors associated with disease regression.
PATIENTS AND METHODS: Retrospective review of consecutive patients with Barrett's esophagus who underwent Nissen fundoplication from 1999 to 2011 by a single surgeon. Postoperative surveillance included yearly upper endoscopy with biopsies. Logistic regression was performed to identify risk factors associated with regression and persistence of Barrett's esophagus.
RESULTS: One hundred and twenty-six patients (73 men; mean age 48 [21-79] years) with Barrett's esophagus underwent Nissen fundoplication. At a median follow-up of 12 (range, 12-36) months, 113 patients (90%) had excellent symptom control and 13 patients (10%) required regular proton pump inhibitor therapy. Regression of Barrett's esophagus was found in 50 patients (40%). All patients with preoperative low-grade dysplasia (n=4) showed evidence of regression. Zero patients developed dysplasia or adenocarcinoma after antireflux surgery. An interval <90 days between diagnosis of Barrett's esophagus and antireflux surgery and body mass index ≤30 significantly correlated with regression of Barrett's esophagus (0.001 and 0.009, respectively).
CONCLUSION: Laparoscopic Nissen fundoplication by a single surgeon resulted in regression of Barrett's esophagus in 40 percent of patients. Risk factors for persistent Barrett's esophagus after antireflux surgery in this study included a duration between diagnosis of Barrett's esophagus and antireflux surgery of <90 days and body mass index <30.
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