Long-Term Outcome of Antireflux Surgery in Patients With Barrett’s Esophagus

作者：Wayne Lewis Hofstetter, Jeffrey H. Peters, Tom R. DeMeester, Jeffrey A. Hagen, Steven R. DeMeester, Peter F. Crookes, Peter I-Hsuan Tsai, F BANKI, Cedric G. Bremner · 发表于：Annals of Surgery · 年份：2001 · DOI：10.1097/00000658-200110000-00012 · 被引用次数：199 · 研究领域：Esophageal Cancer Research and Treatment、Gastroesophageal reflux and treatments、Esophageal and GI Pathology

OBJECTIVE: To assess the long-term outcome of antireflux surgery in patients with Barrett's esophagus. SUMMARY BACKGROUND DATA: The prevalence of Barrett's esophagus is increasing, and its treatment is problematic. Antireflux surgery has the potential to stop reflux and induce a quiescent mucosa. Its long-term outcome, however, has recently been challenged with reports of poor control of reflux and the inability to prevent progression to cancer. METHODS: The outcome of antireflux surgery was studied in 97 patients with Barrett's esophagus. Follow-up was complete in 88% (85/97) at a median of 5 years. Fifty-nine had long-segment and 26 short-segment Barrett's. Patients with intestinal metaplasia of the cardia were excluded. Fifty patients underwent a laparoscopic procedure, 20 a transthoracic procedure, and 3 abdominal Nissen operations. Nine had a Collis-Belsey procedure and three had other partial wraps. Outcome measures included relief of reflux symptoms (all), patients' perception of the result (all), upper endoscopy and histology (n = 79), and postoperative 24-hour pH monitoring (n = 21). RESULTS: At a median follow-up of 5 years, reflux symptoms were absent in 67 of 85 patients (79%). Eighteen (20%) developed recurrent symptoms; four had returned to taking daily acid-suppression medication. Seven patients underwent a secondary repair and were asymptomatic, increasing the eventual successful outcome to 87%. Recurrent symptoms were most common in patients undergoing Collis...