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Indications du traitement chirurgical dans l’endobrachyœsophage

Indications for surgery in Barrett’s esophagus

  • Published:
Acta Endoscopica

Résumé

La chirurgie anti-reflux est indiquée chez les porteurs d’un endobrachyœsophage uniquement après échec du traitement médical car le traitement chirurgical ne procure, ni une régression complète de l’épithélium métaplasique, ni une prévention du développement ultérieur de la dysplasie et/ou de l’adénocarcinome.

L’endobrachyœsophage avec sténose doit être traité par dilatations ou en cas d’échec, par chirurgie anti-reflux associée à une dilatation per-opératoire. Les sténoses résistantes aux dilatations justifient la résection avec reconstruction appropriée conçue en vue de prévenir le reflux acide.

Les ulcères de Barrett peuvent, dans la majorité des cas, être traités avec succès par les moyens médicaux. La chirurgie anti-reflux est efficace lorsque le traitement médical échoue. Les complications telles que les hémorragies massives ou la perforation, nécessitent indiscutablement un traitement chirurgical.

L’œsophago-gastrectomie est recommandée pour les patients dont les biopsies démontrent une dysplasie de haut degré et/ou un carcinome in situ, de même qu’en cas de cancer invasif.

Summary

Antireflux surgery for patients with Barrett’s esophagus is indicated only after failure of medical therapy since neither complete regression of the metaplastic epithelium nor prevention of the subsequent development of dysplasia and/or carcinoma is accomplished thereby.

Barrett’s esophagus with stricture may be managed by Gougienage, or, if this fails, by antireflux surgery coupled with intraoperative dilation. Strictures resistant to bougienage require resection with appropriate reconstruction designed to prevent acid reflux.

Barrett’s ulcers can be managed successfully by medical means in most cases. Antireflux surgery is successful when medical therapy fails. Complications such as massive hemorrhage or perforation, of course, require surgical intervention.

Esophagogastrectomy is recommended for patients with endoscopic biopsy evidence of high grade dysplasia/carcinoma in situ as it is for invasive carcinoma.

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  1. Harvard Medical School, Division of Cardiothoracic Surgery, New England Deaconess Hospital, 110, Francis Street, Suite 2C, 02215, Boston, MA, U.S.A.

    F. H. Ellis

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  1. F. H. Ellis
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Ellis, F.H. Indications du traitement chirurgical dans l’endobrachyœsophage. Acta Endosc 23, 101–108 (1993). https://doi.org/10.1007/BF02968620

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  • DOI: https://doi.org/10.1007/BF02968620

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