Late results of the surgical treatment of 125 patients with short-segment Barrett esophagus

Arch Surg. 2009 Oct;144(10):921-7. doi: 10.1001/archsurg.2009.83.

Abstract

Hypothesis: The results of surgical treatment of patients with long-segment Barrett esophagus (BE) have been extensively reported. However, few publications refer to the results of surgery 5 years after the fact among patients with short-segment BE. This study aimed to determine the late results of 3 surgical procedures in patients with short-segment BE by subjective and objective measurements.

Design: Prospective, nonrandomized study starting on March 1, 1987, and ending on December 31, 2005.

Setting: A prospective, descriptive study of a group of patients.

Patients: A total of 125 patients with short-segment BE underwent 3 operations in different periods: duodenal switch plus highly selective vagotomy and antireflux technique in 31 patients, vagotomy plus partial gastrectomy and Roux-en-Y loop with antireflux surgery in 58 patients, and laparoscopic Nissen fundoplication in 36 patients.

Main outcome measures: Late subjective and objective outcomes of the 3 different surgical procedures.

Results: No operative mortality and only 2 postoperative complications (1.6%) occurred. The regression from intestinal metaplasia to cardiac or oxyntocardiac mucosa occurred in 60.8% to 65.4% of the patients, at a mean time of 39 to 56 months after surgery. Visick grading showed Visick grade I or II in 86.3% to 100.0% of the patients. No progression to low- or high-grade dysplasia or adenocarcinoma occurred.

Conclusions: On the basis of these results, laparoscopic Nissen fundoplication seems to be the surgical option for patients with short-segment BE because it is less invasive, has fewer side effects, and produces good results in the long-term follow-up.

Publication types

  • Comparative Study

MeSH terms

  • Anastomosis, Roux-en-Y*
  • Barrett Esophagus / pathology*
  • Barrett Esophagus / surgery*
  • Esophageal pH Monitoring
  • Follow-Up Studies
  • Fundoplication*
  • Gastrectomy*
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / pathology
  • Gastroesophageal Reflux / therapy*
  • Humans
  • Laparoscopy
  • Middle Aged
  • Prospective Studies
  • Time Factors
  • Treatment Outcome
  • Vagotomy, Proximal Gastric