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

The aim of this study was to demonstrate the efficacy of laparoscopic antireflux surgery in controlling Barrett's esophagus progression, through functional study.

Between January 2008 and December 2009, 21 patients with a preoperative diagnosis of Barrett's esophagus underwent Nissen-Rossetti fundoplication.

All patients underwent preoperatively a 24-hour pH-metry (100%). Twenty patients (95.2%) had postoperative pH monitoring at six months, 16 patients at 12 months (76.2%), eight at 24 months (57.14%). Median De Meester and Johnson score was preoperatively 18.55 (range 8.6-179.7), at six months 7.65 (range 6.4-13), at 12 months 7.5 (range 6.4-14.2), at 24 months 11.95 (range 6.4-20.6). CLE was still present in 18 patients (18/21, 85.7%), but no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric- and one patient with intestinal metaplasia showed complete regression at 12 and 24 months after fundoplication (3/21, 14.3%). Symptom control alone does not manage acid reflux in patients with Barrett's esophagus after surgery, and postoperative 24-hour pH-metry confirms acid reflux abolition. A persistent reflux is more likely to develop cancer than in monitored patients.

Only the presence of intact and effective anti-reflux wrap guarantees protection of the esophagus against CLE progression or its regression. Functional study after surgery identifies patients with Barrett's progression risk.