Results of the Collis-Nissen gastroplasty to control reflux disease in patients who have Barrett's esophagus.

Barrett's esophagus is an end-stage gastroesophageal reflux complication with a potential for malignant transformation. This condition probably is involved in esophageal cancer being perceived today as the most rapidly increasing cancer in Western countries. Numerous observations suggest that standard antireflux operations fail over time because of long-term inflammatory and fibrotic changes in the esophageal wall that cause shortening of the esophagus. The addition of esophageal elongation by gastroplasty provides a reliable repair by creation of a tension-free repair, whereas the durable antireflux effects are provided by the total fundoplication around the neoesophagus. The restored LES tone further helps control the mucosal damage and the chronic inflammatory changes. Complete regression of the abnormal mucosa still does not occur, and persistent irritation of that mucosa still entails the risk for progression toward dysplasia. The natural history of the columnar-lined mucosa in BE may be altered by medical or surgical intervention. It is too early to judge in which settings these interventions will be meaningful.