Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

Herbella, Fernando A. M.; Schlottmann, Francisco; Patti, Marco G.

doi:10.1007/s00268-017-4394-8

Cited by 8 publications

(4 citation statements)

References 70 publications

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“…Most surgeons have employed NF as surgical treatment for BE patients considering that it should be enough to stop the mixed refluxate to the esophagus. 1,6,39 In a systematic review, 8 only 19/35 (57%) mentioned pH-monitoring after NF, all with positive values. Hence, the evidence shows that the concept of NF as good therapy for BE is inaccurate.…”

Section: Discussionmentioning

confidence: 99%

Long-term (18 Years) Results of Patients With Long-segment Barrett Esophagus Submitted to Acid Suppression-duodenal Diversion Operation

et al. 2023

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Objective: To determine late results of AS-DD procedure in long-segment (LSBE) and extralong-segment BE (ELSBE) using subjective and objective measurements to ascertain the histological impact over intestinal metaplasia (IM) and progression to EAC. Summary of Background Data: Barrett esophagus (BE) is a known precursor of esophageal adenocarcinoma (EAC), and Nissen fundoplication has proven to be unable to stop mixed reflux among them. Our group proposed a surgical procedure that handles pathophysiological changes responsible for BE. Methods: This prospective study included 127 LSBE and ELSBE subjects submitted to clinical and functional analyses. They were presented to selective vagotomy, fundoplication, partial gastrectomy with Roux-en-Y reconstruction. The changes in IM were determined in both groups. Results: Follow-up was completed at a mean of 18 years in 81% of the cases. Visick I-II scores were seen in 88% of LSBE and 65% in ELSBE (P < 0.01). There was significant healing of erosive esophagitis and esophageal peptic ulcers, and strictures were resolved in 71%. There was 38% of IM regression in LSBE. Two cases in each group progressed to EAC at a mean of 15 years. Pathologic acid reflux was abolished in 91% and duodenal in 100%. There was a regression of low-grade dysplasia to IM in 80%. Conclusions: AS-DD permanently eliminates pathologic refluxate to the esophagus. The progression to HGD/EAC is lower compared to medical treatment, with an 8-fold reduction in LSBE and 2.2-fold in ELSBE. AS-DD seems to influence IM behaviors, and it is a tool that could reduce and delay progression to EAC.

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Section: Discussionmentioning

confidence: 99%

Long-term (18 Years) Results of Patients With Long-segment Barrett Esophagus Submitted to Acid Suppression-duodenal Diversion Operation

et al. 2023

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“…A HH is a common, chronic disease of the digestive tract with complex etiology and high incidence. The condition is also associated with severe complications such as bleeding, ulceration and erosion caused by re ux, which may lead to esophageal stenosis, and malignant transformation leading to esophageal adenocarcinoma [6,7]. Long-term re ux has a serious negative impact on a patient's life, and many patients worry about the effect of surgical treatment, so they often suffer from insomnia and anxiety [8].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing postoperative symptom improvement in hiatal hernia patients and construction of a clinical prediction model

Huang,

Ma,

et al. 2023

Preprint

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Purpose: Our purpose was to analyze the factors influencing the improvement of symptoms postoperatively in patients with a hiatal hernia (HH), and build a clinical prediction model. Methods: The records of 121 patients with a HH who received surgery at the Sixth Affiliated Hospital of Sun Yat-Sen University from April 2019 to October 2022 were retrospectively reviewed. Patients were divided into a good improvement group (88 patients) and a poor improvement group (33 patients) according to the improvement of symptoms postoperatively. Patient demographic and clinical data, and high-resolution manometry (HRM) data were extracted from the records, and data of the 2 groups were compared by univariate analysis. Statistically significant factors (p<0.05) were incorporated into a multivariate logistic regression model to determine independent factors of postoperative symptom improvement. A clinical prediction model and a nomogram were constructed. Receiver operating characteristic (ROC) curve and calibration curve analysis were used to predict the accuracy of the model. Decision curve analysis (DCA) was used to evaluate the clinical applicability of the model. Results: Multivariate logistic regression analysis showed that non-smoking history and level of distal contraction integral (DCI) were independent factors affecting postoperative symptom improvement of HH patients. The accuracy of the test scoring system shows that the C index is 0.878. Conclusion:The Improvement of symptoms postoperatively in HH patients is affected by smoking history and DCI level. The clinical prediction model established based on these results has good efficacy in predicting the outcomes of patients with a HH who undergo surgery.

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“…It is common knowledge that a clinically successful fundoplication is capable of providing satisfactory control of duodenal-gastro-esophageal reflux 26 . However, the timing for indication of this surgical procedure, for patients with BE and ED, is still a challenge 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Although this may be true, there is still insufficient data related to the changes in esophageal motility and its evolution after surgical treatment of GERD and BE [23][24][25] . However, when successful, LNF provides less exposure to acid and bile salt content, reducing esophageal erosion and, consequently, diminished the metaplastic process present in BE 26,27 .…”

Section: Abstract Abstractmentioning

confidence: 99%

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett’s esophagus?

Falcäo

Nasi

Szachnowicz

et al. 2020

Rev. Col. Bras. Cir.

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Objective: to evaluate esophageal dysmotility (ED) and the extent of Barrett’s esophagus (BE) before and after laparoscopic Nissen fundoplication (LNF) in patients previously diagnosed with BE and ED. Methods: twenty-two patients with BE diagnosed by upper gastrointestinal (GI) endoscopy with biopsies and ED diagnosed by conventional esophageal manometry (CEM) were submitted to a LNF, and followed up with clinical evaluations, upper GI endoscopy with biopsies and CEM, for a minimum of 12 months after the surgical procedure. Results : sixteen patients were male (72.7%) and six were females (27.3%). The mean age was 55.14 (± 15.52) years old. and the mean postoperative follow-up was 26.2 months. The upper GI endoscopy showed that the mean length of BE was 4.09 cm preoperatively and 3.91cm postoperatively (p=0.042). The evaluation of esophageal dysmotility through conventional manometry showed that: the preoperative median of the lower esophageal sphincter resting pressure (LESRP) was 9.15 mmHg and 13.2 mmHg postoperatively (p=0.006). The preoperative median of the esophageal contraction amplitude was 47.85 mmHg, and 57.50 mmHg postoperatively (p=0.408). Preoperative evaluation of esophageal peristalsis showed that 13.6% of the sample presented diffuse esophageal spasm and 9.1% ineffective esophageal motility. In the postoperative, 4.5% of patients had diffuse esophageal spasm, 13.6% of aperistalsis and 22.7% of ineffective motor activity (p=0.133). Conclusion: LNF decreased the BE extension, increased the LES resting pressure, and increased the amplitude of the distal esophageal contraction; however, it was unable to improve ED.

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Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

Abstract: In conclusion, a fundoplication efficiently controls GERD and symptoms in BE patients. A fundoplication (or even better a bile diversion procedure) may also prevent esophageal adenocarcinoma.

Cited by 8 publications

References 70 publications

Long-term (18 Years) Results of Patients With Long-segment Barrett Esophagus Submitted to Acid Suppression-duodenal Diversion Operation

Long-term (18 Years) Results of Patients With Long-segment Barrett Esophagus Submitted to Acid Suppression-duodenal Diversion Operation

Factors influencing postoperative symptom improvement in hiatal hernia patients and construction of a clinical prediction model

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett’s esophagus?

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