INTRODUCTION: The long-term management of gastroesophageal reflux in patients with Barrett's esophagus (BE) is not well supported by an evidence-based consensus. We compare treatment outcome in patients with and without BE submitted tostandardized laparoscopic antireflux surgery (LARS) or esomeprazole treatment. METHODS: In the Long-Term Usage of Acid Suppression Versus Antireflux Surgery trial (a European multicenter randomized study), LARS was compared with dose-adjusted esomeprazole (20-40 mg daily). Operative difficulty, complications, symptom outcomes [Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD)], and treatment failure at 3 years and pH testing (after 6 months) are reported. RESULTS: Of 554 patients with gastroesophageal reflux disease, 60 had BE-28 randomized toesomeprazole and 32 to LARS. Very few BE patients on either treatment strategy (four of 60) experienced treatment failure during the 3-year follow-up. Esophageal pH in BE patients was significantly better controlled after surgical treatment than after esomeprazole (p = 0.002), although mean GSRS and QOLRAD scores were similar for the two therapies at baseline and at 3 years. Although operative difficulty was slightly greater in patients with BE than those without, there was no difference in postoperative complications or level of symptomatic reflux control. CONCLUSION: In a well-controlled surgical environment, the success of LARS is similar in patients with or without BE and matches optimized medical therapy.
RCT Entities:
INTRODUCTION: The long-term management of gastroesophageal reflux in patients with Barrett's esophagus (BE) is not well supported by an evidence-based consensus. We compare treatment outcome in patients with and without BE submitted to standardized laparoscopic antireflux surgery (LARS) or esomeprazole treatment. METHODS: In the Long-Term Usage of Acid Suppression Versus Antireflux Surgery trial (a European multicenter randomized study), LARS was compared with dose-adjusted esomeprazole (20-40 mg daily). Operative difficulty, complications, symptom outcomes [Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD)], and treatment failure at 3 years and pH testing (after 6 months) are reported. RESULTS: Of 554 patients with gastroesophageal reflux disease, 60 had BE-28 randomized to esomeprazole and 32 to LARS. Very few BE patients on either treatment strategy (four of 60) experienced treatment failure during the 3-year follow-up. Esophageal pH in BE patients was significantly better controlled after surgical treatment than after esomeprazole (p = 0.002), although mean GSRS and QOLRAD scores were similar for the two therapies at baseline and at 3 years. Although operative difficulty was slightly greater in patients with BE than those without, there was no difference in postoperative complications or level of symptomatic reflux control. CONCLUSION: In a well-controlled surgical environment, the success of LARS is similar in patients with or without BE and matches optimized medical therapy.
Authors: G M Campos; J H Peters; T R DeMeester; S Oberg; P F Crookes; S Tan; S R DeMeester; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452
Authors: W L Hofstetter; J H Peters; T R DeMeester; J A Hagen; S R DeMeester; P F Crookes; P Tsai; F Banki; C G Bremner Journal: Ann Surg Date: 2001-10 Impact factor: 12.969
Authors: Prateek Sharma; John Dent; David Armstrong; Jacques J G H M Bergman; Liebwin Gossner; Yoshio Hoshihara; Janusz A Jankowski; Ola Junghard; Lars Lundell; Guido N J Tytgat; Michael Vieth Journal: Gastroenterology Date: 2006-08-16 Impact factor: 22.682
Authors: Eugene Y Chang; Cynthia D Morris; Ann K Seltman; Robert W O'Rourke; Benjamin K Chan; John G Hunter; Blair A Jobe Journal: Ann Surg Date: 2007-07 Impact factor: 12.969
Authors: Dimitrios Stefanidis; William W Hope; Geoffrey P Kohn; Patrick R Reardon; William S Richardson; Robert D Fanelli Journal: Surg Endosc Date: 2010-08-20 Impact factor: 4.584
Authors: Jon C Gould; Mark R Wendling; Brant K Oeschlager; Sumeet K Mittal; Srinadh Komanduri; Kyle A Perry; Sean Cleary; Susan Galandiuk; Daniel J Scott; P Marco Fisichella; Nicholas J Shaheen; Kelly R Haisley; John G Hunter Journal: J Gastrointest Surg Date: 2017-02-27 Impact factor: 3.452
Authors: Melina C Vassiliou; Daniel von Renteln; Daniel C Wiener; Stuart R Gordon; Richard I Rothstein Journal: Surg Endosc Date: 2009-08-27 Impact factor: 4.584