Abstracts
1998 Digestive Disease Week

#3755

LAPAROSCOPIC FUNDOPLICATION IN PATIENTS WITH BARRETT'S ESOPHAGUS. S. Öberg, J.H Peters, T.R DeMeester, M.P. Ritter, P.A. Crookes, S.R. DeMeester, J.A. Hagen, C.G. Bremner. Department of Surgery, University of Southern California, Los Angeles, California.

Barrett's esophagus is an increasing public health concern but no clear consensus exists regarding the roles of medical and surgical therapy. The aim of this study was to evaluate the efficacy of laparoscopic fundoplication in the symptomatic treatment of gastroesophageal reflux disease (GERD) in patients with Barrett's esophagus.

Methods: Thirty five patients with symptomatic Barrett's esophagus and 55 patients with typical symptoms of GERD (Heartburn, regurgitation, dysphagia) but no Barrett's esophagus underwent laparoscopic fundoplication in the period 3/93-6/96. Physician and patient assessment of symptomatic outcome was obtained via a standardized questionnaire at a mean of 20 months following surgery (range 6-40 months). The outcome was considered excellent in asymptomatic patients, good when the primary symptom was relieved but minor gastrointestinal symptoms remained, fair when the primary symptom was improved but persisted and/or there was necessity for additional therapy and poor when symptoms were equal or worse than before surgery. Acid exposure, esophageal clearance and sphincter characteristics as well as pre and postoperative symptom scores were compared between the two groups.

Results: Patients with Barrett's esophagus had significantly more severe disease as evidenced by higher esophageal acid exposure (% time pH < 4, 22.6% vs 10.6%, p < 0.01) when compared to the non Barrett group. Furthermore, patients with Barrett's esophagus had lower mean esophageal contraction amplitudes (61.0 mmHg vs 79.3 mmHg, p < 0.05) and higher number of reflux episodes with long duration (11.3 vs 3.6, p < 0.05), indicating impaired esophageal clearance and a later stage of disease. Despite the severity of disease, an excellent (22/35) to good (11/35) outcome was achieved in 94 percent of the Barrett's patients which was not different from the non Barrett group where a good or excellent outcome was found in 52 of 55 (94%) patients (p=1.0). Eighty three percent of the Barrett's patients considered themselves cured, 17% improved and none worsened by the procedure. The mean hospital stay was 3.2 days. There was no mortality.

Conclusions: Laparoscopic antireflux surgery results in excellent relief of symptoms in patients with Barrett's esophagus. The concept that medical therapy is the treatment of choice for patients with Barrett's esophagus should be seriously challenged.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.