Abstracts
1998 Digestive Disease Week
#2329
BARRETT'S ESOPHAGUS: A SURGICAL DISEASE. M.G. Patti, C.V. Feo, M. Arcerito, S. Worth, M. De Pinto, J. Tong, V.C. Gibbs, M. Ahmadi, W. Gantert, D. Tyrrell, L.D. Ferrell, and L.W. Way, Department of Surgery, University of California, San Francisco. San Francisco, California.
Background: Barrett's metaplasia can develop in patients with gastroesophageal reflux disease (GERD), and metaplasia can evolve into high grade dysplasia and adenocarcinoma. Nevertheless, the optimal treatment for Barrett's metaplasia and dysplasia is still debated.
Goals: To assess: (a) the incidence of Barrett's esophagus among pts with GERD; (b) the ability of laparoscopic fundoplication to control symptoms in patients with Barrett's metaplasia; and (c) the results of esophagectomy in patients with high grade dysplasia.
Patients and Methods: Thirty-eight symptomatic patients with GERD and Barrett's metaplasia underwent laparoscopic fundoplications. Eleven other consecutive patients with high grade dysplasia (HGD) underwent transhiatal esophagectomies.
Results: Barrett's metaplasia was present in 72 of 637 consecutive patients with GERD (11%) evaluated in our Swallowing Center between October 1989 and February 1997.
A. Laparoscopic Fundoplication (38 pts)
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Preoperative
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Postoperative
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p-value
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LES presuure (mmHg)
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6 ± 3
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14 ± 7
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<0.01
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Distal esophageal amplitude (mmHg)
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50 ± 35
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54 ± 25
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NS
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heartburn score (0-4)*
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3.5 ± 0.5
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0.2 ± 0.7
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< 0.01
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Regurgitation score (0-4)*
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2.9 ± 0.9
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0.1 ± 0.7
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<0.01
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Cough (0-4)*
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2.7 ± 1.1
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0
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< 0.01
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* Heartburn resolved in 95% of pts, regurgitation in 93% of pts, and cough in 100% of pts.
B. Transhiatal Esophagectomy (11 pts)
Average duration of the operation was 339 ± 89 minutes. The only significant complications were two esophageal leaks that resolved within 30 days. Mean hospital stay was 14 ± 5 days. There were no deaths. The specimens showed HGD in 7 pts and invasive adenocarcinoma (undiagnosed preoperatively) in 4 pts (36%) (T1N0M0, T2N0M0, T1N1M0, T2N1M0).
Conclusions: These results show that: (a) Barrett's esophagus was present in 11% of pts with GERD seen in a busy diagnostic center; (b) laparoscopic fundoplication was highly successful in controlling symptoms in pts with Barrett's metaplasia; (c) in patients with HGD, esophagectomy can be performed safely, and invasive cancer continues to elude preoperative biopsy in one-third of such pts.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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