Authors: Attila Csendes
Publish Date: 2004/02/17
Volume: 28, Issue: 3, Pages: 225-231
Abstract
Barrett’s esophagus is a complication of longstanding gastroesophageal reflux and can be a premalignant condition The goals of surgical treatment which were well summarized by DeMeester have been increased and more detailed by us They consist of 1 controlling symptoms of gastroesophageal reflux disease 2 abolishing acid and duodenal reflux into the esophagus 3 preventing or eliminating the development of complications 4 preventing extension of or an increase in the length of intestinal metaplasia 5 inducing regression of intestinal metaplasia to the cardiac mucosa and 6 preventing progression to dysplasia thereby inducing regression of lowgrade dysplasia and avoiding the appearance of an adenocarcinoma We have reviewed 25 articles in the Englishlanguage literature published from 1980 to 2003 dealing specifically with the surgical treatment of Barrett’s esophagus In most of these papers too few patients were included the followup was less than 60 months and the clinical success deteriorated with time Acid reflux persists after surgery in nearly 35 of Barrett’s esophagus patients and at 10 years after surgery duodenal reflux is present in 95 Peptic ulcer stricture and erosive esophagitis are present in 15 to 30 late after surgery and in 16 there is progression of the intestinal metaplasia There is the appearance of lowgrade dysplasia in 60 and adenocarcinoma in 34 and there is regression of lowgrade dysplasia in 450 These results challenge the arguments supporting antireflux surgery for patients with Barrett’s esophagus The clinical results are not optimal no longlasting effect has been demonstrated and it does not prevent the appearance of dysplasia or adenocarcinoma An excellent alternative is acid suppression and a duodenal diversion procedure which has had 91 clinical success for more than 5 years This regimen has almost eliminated acid and duodenal reflux and there has been no progression to dysplasia or adenocarcinoma Moreover in 60 of the patients with lowgrade dysplasia regression to nondysplastic mucosa has occurred
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