Long-Term Results of a Randomized Prospective Study Comparing Medical and Surgical Treatment of Barrett’s Esophagus

Parrilla, Pascual; Haro, Luisa F. Martínez de; Ortiz, A. S.; Munítiz, Vicente; Molina, Joaquín; Bermejo, Juan; Canteras, Manuel

doi:10.1097/01.sla.0000055269.77838.8e

Cited by 191 publications

(143 citation statements)

References 26 publications

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“…One relatively small randomized trial showed no diff erence in progression outcomes between medical and surgical groups ( 169 ), but this result is susceptible to type II error. Meta-analyses on the subject reveal confl icting results, in that some authors have found no diff erence in cancer risk between medically and surgically managed patients, whereas others show some suggestion of improved outcomes in surgically treated patients (170)(171)(172).…”

Section: Surgical Therapymentioning

confidence: 94%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Surgical Therapymentioning

confidence: 94%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

View full text Add to dashboard Cite

show abstract

“…There were not enough patients in the surgical arm to determine if this was a significant difference. Parrilla et al have published the only randomized study comparing 43 patient treated with medical treatment and 58 with antireflux surgery (Parrilla et al 2003). In that study, 101 patients with BE were treated between 1982 and 2000.…”

Section: Barrett's Esophagusmentioning

confidence: 99%

Surgical Treatment of Gastroesophageal Reflux Disease

Tosato¹,

Marano²,

Mattacchione³

et al. 2011

Advances in Endoscopic Surgery

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“…This is partly due to the fact that medical therapy with proton pump inhibitors (PPIs) seem to provide a 93% symptom remission (Lundell et al, 2008), and studies that show both medical and surgical treatments are highly effective, safe and well tolerated (Mahon et al, 2005;Ortiz et al, 1996;Parrilla et al, 2003;Spechler, 1992;Spechler et al, 2001) and improve QoL of GERD patients. Gillies and colleagues (Gillies et al, 2008) showed that laparoscopic anti-reflux surgery also improved the QoL of patients whose symptoms were well controlled on medical therapy.…”

Section: Symptomsmentioning

confidence: 99%