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Barrett's epithelium after antireflux surgery
Giovanni Zaninotto1, Mauro Cassaro, Gianmaria Pennelli
1Department of General Surgery, University of Padova School of Medicine, Italy.
Summary
Antireflux surgery can reverse intestinal metaplasia in short-segment Barrett's esophagus (BE), but not in long-segment BE. This finding suggests surgical intervention may alter BE's histologic progression.
Area of Science:
- Gastroenterology
- Esophageal Diseases
- Surgical Oncology
Background:
- Barrett's esophagus (BE) is intestinal metaplasia in the esophagus, linked to GERD.
- Effective GERD treatment may induce BE regression.
- Laparoscopic fundoplication is a common antireflux surgery.
Purpose of the Study:
- To assess if laparoscopic fundoplication alters endoscopic and histologic features of BE.
- To compare outcomes in short-segment BE (SBE) versus long-segment BE (LBE).
Main Methods:
- 35 BE patients (11 SBE, 24 LBE) underwent fundoplication.
- Extensive esophageal biopsies were taken pre- and post-surgery (mean 28-month follow-up).
- Histology assessed intestinal metaplasia (IM) extension, phenotype (HID stain), and Cdx2 expression.
Main Results:
- Significant IM reduction and shift to complete-type IM in SBE post-surgery.
- No significant changes in IM extension or phenotype for LBE.
- Decreased Cdx2 protein expression observed only in SBE patients.
Conclusions:
- Antireflux surgery significantly modifies the histologic phenotype of SBE.
- Laparoscopic fundoplication does not induce significant histologic changes in LBE.
- Surgical intervention may be a viable option for managing SBE.