[Radical surgical treatment of Barrett's esophagus]

In the light of modern scientific knowledge, pathogenesis of Barrette's esophagus (BE) is presented as an integral neoplastic process. Indications to operation and policy of radical surgical treatment in BE, including in combined esophageal diseases (burn and peptic strictures, reflux esophagitis, short esophagus) were developed. From 1990 to 2000 radical operations were performed in 14 patients (11 males, 3 females) with BE. Mean age was 54.1 years. About 80% patients had clinical signs of reflux esophagitis at the moment of hospitalization. In all the patients the diagnosis of BE was verified in microscopic examination of operative material. 4 patients with cylindrical metaplasia associated with ulcers and esophageal peptic strictures were operated, 3 patients--with epithelium dysplasia, 7 patients--with adenocarcinoma. All the patients underwent extirpation of thoracic portion of esophagus with one-stage plasty with isoperistaltic gastric tube, supplemented with mediastinal and abdominal lymphodissection in cancer. Affection of the regional lymph nodes was revealed in 43% patients with esophageal adenocarcinoma. 50% patients had complications in postoperative period. There were no cases of hospital lethality. The expansion of indications for early surgical treatment of BE at the stage of meta-, and dysplasia, before adenocarcinoma development, is thought valid.