Skip to main content
SpringerLink
Log in

Clinical and histologic follow-up after antireflux surgery for Barrett’s esophagus

  • Published:
Journal of Gastrointestinal Surgery

Abstract

There are few prospective studies that document the histologic follow-up after antireflux surgery in patients with Barrett’s esophagus, as defined by the recently standardized criteria. We report the clinical, endoscopic, and histologic results of patients with Barrett’s esophagus followed postoperatively for at least 2 years. Diagnosis of Barrett’s esophagus required preoperative endoscopic evidence of columnarlined epithelium in the esophagus and a biopsy demonstrating specialized intestinal metaplasia, which stains positively with Alcian blue stain. Between April 1993 and November 1998, a total of 104 patients meeting these criteria underwent fundoplication (laparoscopic [n = 84] or open [n = 6] nissen, laparoscopic Toupet [n = 11], laparoscopic Collis-Nissen [n = 1], Collins-Toupet [n = 1] or open Dor [n = 1]). Short-segment Barrett’s esophagus (length of intestinal metaplasia <3 cm) was found preoperatively in 34% and low-grade dysplasia in 4% of patients. All patients were contacted yearly by mail, phone, or clinic visit. At a mean follow-up of 4.6 years (range 2 to 7.5 years), 81% of patients had stopped taking antisecretory medications and 97% were satisfied with the results of their operations. Eight patients have undergone reoperation for recurrence of symptoms. Two patients have died and two were excluded from endoscopic biopsy because of portal hypertension. Sixty-six patients complied with the surveillance protocol, and their histologic results were returned to our center. Symptomatic follow-up of the 34 patients who refused surveillance esophagogastro and duodenoscopy revealed two patients who were taking medication for reflux symptoms. None of the patients have developed high-grade dysplasia or esophageal carcinoma during surveillance endoscopy (337 total patient-years of follow-up). The incidence of regression of intestinal metaplasia to cardiac-fundic-type metaplasia after successful antireflux surgery is greater than previously reported. We suspect that this is a result of longer follow-up and the inclusion of patients with short-segment Barrett’s esophagus. A substantial number of patients with Barrett’s esophagus who are asymptomatic after antireflux surgery refuse surveillance endoscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Weinstein,WM, Ippoliti,AF. The diagnosis of Barrett’s esophagus: Goblets, goblets, goblets. Gastrointest Indosc 1996;44:91–95.

    Article  CAS  Google Scholar 

  2. Riddell,RH.The biopsy diagnosis of gastroesophageal reflux disease, ’carditis,’ and Barrett’s esophagus, and sequelae of therapy. Am J Surg Pathol 1996;20(Suppl):S31-S50.

    PubMed  Google Scholar 

  3. Eisen,GM,Sandler,RS,Murray,S,Gottfried,M.The relationship between gastroesophageal reflux disease and its complications with Barrett’s esophagus. Am J Gastroenterol 1997;92:27–31.

    PubMed  CAS  Google Scholar 

  4. Winters,C,Spurling,TJ,Chobanian,SJ, et al. Barrett’s esophagus: A prevalent, occult complication of gastroesophageal reflux. Gastroenterology 1987;92:118–124.

    PubMed  Google Scholar 

  5. Hunter,JG,Smith,CD,Branum,GD, et al. Laparoscopic fundoplication failures: Patterns of failure and response to fundoplication revision. Ann Surg 1999;230:595–606.

    Article  PubMed  CAS  Google Scholar 

  6. Csendes,A,Braghetto,I,Burdiles,P, et al. 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. Surgery 1998;123:645–657.

    PubMed  CAS  Google Scholar 

  7. Farrell,TM,Smith,CD,Metrevelli,RE, et al. Fundoplication provides effective and durable symptom relief in patients with Barrett’s esophagus. Am J Surg 1999;178:18–21.

    Article  PubMed  CAS  Google Scholar 

  8. Waring,JP,Hunter,JG,Oddsdottir,M, et al. The preoperative evaluation of patients considered for laparoscopic antireflux surgery. AmJ Gastroenterol 1995;90:35–38.

    CAS  Google Scholar 

  9. Hunter,JG,Trus,TL,Branum,GD, et al. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;223:673687.

    Article  Google Scholar 

  10. Reid,BJ,Blount,PL,Rubin,CE, et al. Flow-cytometric and histological progression to malignancy in Barrett’s esophagus: Prospective endoscopic surveillance of a cohort. Gastroenterology 1992;102:1212–1219.

    PubMed  CAS  Google Scholar 

  11. Trus,TL,Laycock,WS,Waring,JP, et al. Improvement in quality of life measures after laparoscopic antireflux surgery. Ann Surg 1999;229:331–336.

    Article  PubMed  CAS  Google Scholar 

  12. Ware JE. Norm-based interpretation. In JE Ware, ed. SF-36 Health Survey: Manual & Interpretation Guide. Lincoln, Rhode Island, 2000: Quality Metric, Inc.

  13. Bowers SP, Mattar SG, Hunter JG, et al. KTP laser ablation after successful antireflux surgery provides durable regression of Barrett’s esophagus. Surg Endosc (Accepted for publication).

  14. Haggitt,RC,Tryzelaar,J,Ellis,FH, et al. Adenocarcinoma complicating columnar epithelium-lined (Barrett’s) esophagus. AmJ Clin Pathol 1978;70:1–5.

    CAS  Google Scholar 

  15. Morales,TG,Camargo,E,Bhattacharyya,A,Sampliner,RE. Long-term follow-up of intestinal metaplasia of the gastric cardia. AmJ Gastroenterol 2000;95:1677–1680.

    Article  CAS  Google Scholar 

  16. Sharma,P,Weston,AP,Morales,T, et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut 2000;46:9–13.

    Article  PubMed  CAS  Google Scholar 

  17. Rudolph,RE,Vaughan,TL,Storer,BE, et al. Effect of segment length on risk for neoplastic progression in patients with Barrett’s esophagus. Ann Intern Med 2000;132:612–620.

    PubMed  CAS  Google Scholar 

  18. Sharma,P,Morales,TG,Bhattacharyya,A, et al. Dysplasia in short-segment Barrett’s esophagus: A prospective 3-year follow-up. Am J Gastroenterol 1997;92:2012–2016.

    PubMed  CAS  Google Scholar 

  19. Weston,AP,Krmpotich,PT,Cherian,R, et al. Prospective longterm endoscopic and histologic follow-up of short segment Barrett’s esophagus: Comparison with traditional long segment Barrett’s esophagus. Am J Gastroenterol 1997;92:407–413.

    PubMed  CAS  Google Scholar 

  20. DeMeester,SR,Campos,GMR,DeMeester,TR, et al. The impact of an antireflux procedure on intestinal metaplasia of the cardia. Ann Surg 1998;228:547–553.

    Article  PubMed  CAS  Google Scholar 

  21. Spechler,SJ,Zeroogian,JM,Wang,HH, et al. The frequency of specialized intestinal metaplasia at the squamo-columnar junction varies with the extent of columnar epithelium lining the esophagus. Gastroenterology 1995;108:A224.

    Google Scholar 

  22. Sampliner,RE.Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 1998;93:1028–1032.

    Article  PubMed  CAS  Google Scholar 

  23. Katska,D,Castell,DO. Successful elimination of reflux symptoms does not insure adequate control of acid reflux in patients with Barrett’s esophagus. AmJ Gastroenterol 1994; 89:989–991.

    Google Scholar 

  24. Waring,JP.Postfundoplication complications. Prevention and management. Gastroenterol Clin North Am 1999;28:1007–1019.

    Article  PubMed  CAS  Google Scholar 

  25. Chen,LQ,Nastos,D,Hu,CY, et al. Results of the Collis-Nissen gastroplasty in patients with Barrett’s esophagus. Soc Thorac Surg 1999;68:1014–1021.

    Article  CAS  Google Scholar 

  26. Johnson,AB,Oddsdottir,M,Hunter,JG.Laparoscopic Collis gastroplasty and Nissen fundoplication. A new technique for the management of esophageal foreshortening. Surg Endosc 1998;12:1055–1060.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

    Steven P. Bowers M.D., Samer G. Mattar M.D. & C. Daniel Smith M.D.

  2. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia

    J. Patrick Waring M.D.

  3. Department of Surgery, Oregon Health Sciences University, Portland, Oregon

    John G. Hunter M.D.

Authors
  1. Steven P. Bowers M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samer G. Mattar M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Daniel Smith M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Patrick Waring M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John G. Hunter M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Daniel Smith M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bowers, S.P., Mattar, S.G., Smith, C.D. et al. Clinical and histologic follow-up after antireflux surgery for Barrett’s esophagus. J Gastrointest Surg 6, 532–539 (2002). https://doi.org/10.1016/S1091-255X(02)00033-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(02)00033-1

Key words

Search

Navigation