BACKGROUND: To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett's esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND- or LGD-BE after medical and surgical treatment. METHODS: We studied a cohort of ND- and LGD-BE patients who underwent laparoscopic total fundoplication and a cohort of ND- and LGD-BE patients managed medically. Patients were matched for age, sex, and disease duration. After 1 year of follow-up at least, all patients underwent upper endoscopy with esophageal biopsies to evaluate any histological changes, as well as manometry and impedance-pH-metry to re-assess reflux patterns. RESULTS: Thirty-seven patients (20 LGD, 17 ND) undergoing laparoscopic fundoplication were enrolled and compared with 25 patients (13 LGD, 12 ND) managed with proton pump inhibitors (PPI). Laparoscopic fundoplication resulted in a better control of both acidic and weakly acidic reflux (P < 0.001) and was associated with a higher probability of reversion for LGD (P < 0.01). Esophageal motility did not differ between surgically and medically treated patients. CONCLUSIONS: In patients with ND- or LGD-BE, laparoscopic fundoplication seems to warrant a better control of all kinds of refluxate and it is associated with a higher likelihood of reversion of both LGD- and ND-BE, compared with PPI therapy.
BACKGROUND: To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett's esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND- or LGD-BE after medical and surgical treatment. METHODS: We studied a cohort of ND- and LGD-BE patients who underwent laparoscopic total fundoplication and a cohort of ND- and LGD-BE patients managed medically. Patients were matched for age, sex, and disease duration. After 1 year of follow-up at least, all patients underwent upper endoscopy with esophageal biopsies to evaluate any histological changes, as well as manometry and impedance-pH-metry to re-assess reflux patterns. RESULTS: Thirty-seven patients (20 LGD, 17 ND) undergoing laparoscopic fundoplication were enrolled and compared with 25 patients (13 LGD, 12 ND) managed with proton pump inhibitors (PPI). Laparoscopic fundoplication resulted in a better control of both acidic and weakly acidic reflux (P < 0.001) and was associated with a higher probability of reversion for LGD (P < 0.01). Esophageal motility did not differ between surgically and medically treated patients. CONCLUSIONS: In patients with ND- or LGD-BE, laparoscopic fundoplication seems to warrant a better control of all kinds of refluxate and it is associated with a higher likelihood of reversion of both LGD- and ND-BE, compared with PPI therapy.
Authors: M Rugge; P Correa; M F Dixon; T Hattori; G Leandro; K Lewin; R H Riddell; P Sipponen; H Watanabe Journal: Am J Surg Pathol Date: 2000-02 Impact factor: 6.394
Authors: Stuart J Spechler; Prateek Sharma; Barry Traxler; Douglas Levine; Gary W Falk Journal: Am J Gastroenterol Date: 2006-07-18 Impact factor: 10.864
Authors: Giuseppe Amato; Paolo Limongelli; Annalisa Pascariello; Gianluca Rossetti; Gianmattia Del Genio; Alberto Del Genio; Paola Iovino Journal: Am J Surg Date: 2008-05-07 Impact factor: 2.565
Authors: Gianmattia del Genio; Gianluca Rossetti; Luigi Brusciano; Paolo Limongelli; Francesco Pizza; Salvatore Tolone; Landino Fei; Vincenzo Maffettone; Vincenzo Napolitano; Alberto del Genio Journal: World J Surg Date: 2007-05 Impact factor: 3.352