Barrett's esophagus after laparoscopic Nissen-Rossetti fundoplication: functional evaluation

Area of Science:

• Gastroenterology and Surgical Innovation
• Esophageal Disease Management
• Oncology Prevention

Background:

• Barrett's esophagus is a precancerous condition linked to chronic acid reflux.
• Effective management of acid reflux is crucial for preventing esophageal adenocarcinoma.
• Laparoscopic antireflux surgery offers a potential solution for controlling disease progression.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic antireflux surgery in managing Barrett's esophagus progression.
• To assess the impact of surgery on esophageal acid exposure and metaplasia using functional studies.
• To identify risk factors for Barrett's esophagus progression post-surgery.

Main Methods:

• Twenty-one patients with Barrett's esophagus underwent Nissen-Rossetti fundoplication.
• Preoperative and postoperative 24-hour pH-metry and De Meester and Johnson scores were used for functional assessment.
• Long-term follow-up included monitoring for intestinal metaplasia, dysplasia, and adenocarcinoma.

Main Results:

• Postoperative pH monitoring confirmed significant reduction in acid reflux.
• While 85.7% of patients had persistent Barrett's esophagus (CLE), no dysplasia or adenocarcinoma developed.
• Complete regression of metaplasia occurred in 14.3% of patients within 24 months.
• Symptom control alone is insufficient; functional studies confirm reflux control.

Conclusions:

• An intact and effective antireflux wrap is essential for preventing or reversing Barrett's esophagus progression.
• Postoperative functional studies are critical for identifying patients at risk of disease progression.
• Laparoscopic antireflux surgery, when effective, plays a key role in the oncological surveillance of Barrett's esophagus.