Surgical therapy for Barrett's esophagus

Area of Science:

• Gastroenterology
• Surgical Oncology
• Gastroesophageal Reflux Disease (GERD)

Background:

• Patients with Barrett's esophagus (BE) have significant anatomic and functional defects necessitating effective antireflux surgery.
• BE represents end-stage GERD, demanding durable and reliable reflux control methods.
• Standard procedures like Hill and partial fundoplication have high failure rates in BE patients.

Purpose of the Study:

• To evaluate the efficacy of antireflux surgery in patients with Barrett's esophagus (BE).
• To identify optimal surgical strategies for managing reflux in BE patients, considering short esophagus and potential complications.
• To underscore the importance of excellent reflux control for mitigating cancer progression risk.

Main Methods:

• Review of surgical outcomes for antireflux procedures in BE patients.
• Consideration of laparoscopic Nissen fundoplication, its failure modes (herniation), and adjuncts like Collis gastroplasty.
• Evaluation of transthoracic approaches for improved esophageal mobilization in cases of suspected short esophagus.

Main Results:

• Laparoscopic Nissen fundoplication success rates may be lower in BE patients compared to those with less severe GERD.
• Fundoplication herniation is a common failure mode, particularly in BE patients with short esophagus.
• The long-term effects of residual acid-secreting mucosa after gastroplasty in BE patients require further investigation.

Conclusions:

• Antireflux surgery is essential for managing BE, but requires tailored approaches due to high failure rates with standard techniques.
• Transthoracic fundoplication may be advantageous for patients with short esophagus, potentially avoiding gastroplasty.
• Superior reflux control is paramount for observing differences in dysplasia and cancer progression between surgical and medical management.