Barrett's esophagus after laparoscopic Nissen-Rossetti fundoplication: functional evaluation

Abstract

Aim: The aim of this study was to demonstrate the efficacy of laparoscopic antireflux surgery in controlling Barrett's esophagus progression, through functional study.

Methods: Between January 2008 and December 2009, 21 patients with a preoperative diagnosis of Barrett's esophagus underwent Nissen-Rossetti fundoplication.

Results: All patients underwent preoperatively a 24-hour pH-metry (100%). Twenty patients (95.2%) had postoperative pH monitoring at six months, 16 patients at 12 months (76.2%), eight at 24 months (57.14%). Median De Meester and Johnson score was preoperatively 18.55 (range 8.6-179.7), at six months 7.65 (range 6.4-13), at 12 months 7.5 (range 6.4-14.2), at 24 months 11.95 (range 6.4-20.6). CLE was still present in 18 patients (18/21, 85.7%), but no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric- and one patient with intestinal metaplasia showed complete regression at 12 and 24 months after fundoplication (3/21, 14.3%). Symptom control alone does not manage acid reflux in patients with Barrett's esophagus after surgery, and postoperative 24-hour pH-metry confirms acid reflux abolition. A persistent reflux is more likely to develop cancer than in monitored patients.

Conclusion: Only the presence of intact and effective anti-reflux wrap guarantees protection of the esophagus against CLE progression or its regression. Functional study after surgery identifies patients with Barrett's progression risk.