Article

Surgical Endoscopy

, Volume 26, Issue 7, pp 1892-1897

Long-term results of ablation with antireflux surgery for Barrett’s esophagus: a clinical and molecular biologic study

  • Tuuli KauttuAffiliated withDivision of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital
  • , Jari RäsänenAffiliated withDivision of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital
  • , Leena KrogerusAffiliated withDepartment of Pathology, Helsinki University Central Hospital
  • , Eero SihvoAffiliated withDivision of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital
  • , Pauli PuolakkainenAffiliated withDepartment of Gastroenterologic and General Surgery, Helsinki University Central Hospital
  • , Jarmo A. SaloAffiliated withDivision of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital Email author 

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Abstract

Background

The initial results from ablation therapy for metaplastic/dysplastic Barrett’s esophagus (BE) are promising, but the results of extended follow-up evaluation are seldom reported.

Methods

Neodymium:yttrium–aluminum-garnet laser ablation and successful antireflux surgery for 18 patients with metaplastic BE primarily resulted in the total histologic eradication of BE in 15 patients (83%). After antireflux surgery, the healing of gastroesophageal reflux disease (GERD) was objectively verified in all the patients. At late follow-up evaluation, endoscopy, conventional histology, molecular oxidative stress analyses in comparison with normal control conditions (8-hydroxydeoxyguanosine [8-OHdG], superoxide dismutase [SOD], glutathione [GSH], myeloperoxydase [MP]), and immunohistochemistry (p53, and Cdx2, caudal-related homeobox gene 2, marking intestinal differentiation) of the neosquamous epithelium were performed.

Results

At the end of the follow-up period (range, 3–15 years; mean, 8 years), intestinal metaplasia without dysplasia was detected histologically in eight patients (44%). Six patients had macroscopic BE (mean length, 3.5 cm; range 1–10 cm). The neosquamous epithelium was histologically normal, with no underlying columnar tissue. The fundoplication was endoscopically normal in 14 patients (82%). The 8-OHdG level was higher in the neosquamous epithelium than in the control conditions in the distal esophagus (4.3 vs. 0.52; P = 0.0002) and the proximal esophagus (1.8 vs. 0.95; P = 0.006). Likewise, SOD activity was higher in the neosquamous epithelium (0.38 vs. 0.12; P = 0.0005), whereas MP activity and GSH levels remained normal. Three patients showed slight nuclear p53 expression (typical in normal inflammatory reactions), whereas Cdx2 positivity was confined to one case with recurrent intestinal metaplasia.

Conclusions

The neosquamous mucosa, generated by the ablation of BE and the treatment of GERD with fundoplication, was stable during long-term follow-up evaluation in two-thirds of the patients with initial eradication. It had normal p53 expression and no Cdx2 protein expression. The oxidative stress of the neosquamous esophagus remained high, although the clinical significance of this is unclear.

Keywords

Ablation Antireflux surgery Barrett’s esophagus Immunohistochemistry Long-term follow-up Oxidative stress