Long-term results of classic antireflux surgery in 152 patients with Barrett's esophagus: Clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation

• Published in: Surgery Vol. 123; no. 6; pp. 645 - 657
• Main Authors: Csendes, Attila, Braghetto, Italo, Burdiles, Patricio, Puente, Guillermo, Korn, Owen, Díaz, Juan Carlos, Maluenda, Fernando
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.1998; Elsevier
• Subjects: Adult; Aged; Barrett Esophagus - diagnostic imaging; Barrett Esophagus - surgery; Biological and medical sciences; Endoscopy; Esophagus; Female; Gastroesophageal Reflux - prevention & control; Humans; Hydrogen-Ion Concentration; Male; Manometry; Medical sciences; Middle Aged; Prospective Studies; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Prospective; Evaluation; Surgery; Esophageal disease; Digestive diseases; Barrett esophagus; Technique; Long term
• DOI: 10.1016/S0039-6060(98)70202-8
• ISSN: 0039-6060

Background: The classic surgical procedure for patients with Barrett's esophagus (BE) has been either Nissen fundoplication or posterior gastropexy with calibration of the cardia. Methods: The purpose of our study was to determine late subjective and objective results of these classic surgical techniques in a large number of patients with BE. A total of 152 patients were included in this prospective protocol. Results: There was 1 death (0.7%) after operation. The late follow-up of 100 months demonstrated a high percentage of failures among patients with noncomplicated BE (54%) and an even higher figure in patients with complicated BE (64%). In 15 patients low grade dysplasia appeared at 8 years of follow-up and an adenocarcinoma in 4 patients. Twenty-four–hour pH monitoring demonstrated a decrease in acid reflux into the esophagus, and Bilitec studies also demonstrated a decrease of duodenoesophageal reflux, but in all cases with a higher value than the normal limit. Conclusions: Classic antireflux surgery in patients with BE results in a high percentage of failures at very late follow-up because it cannot completely avoid acid and duodenal reflux into the esophagus. (Surgery 1998;123:645-57.)