Barrett's esophagus. A surgical entity.
During a ten-year period, endoscopy demonstrated acid-peptic esophagitis in 439 patients. Forty of these patients (9.1%) had Barrett's esophagus. Adenocarcinoma was present in the columnar epithelium in 15 (37.5%) of the patients with Barrett's esophagus. Hiatal hernias, with symptoms of heartburn, dysphagia, stricture, and ulceration, were found in more than 75% of the patients with Barrett's esophagus. We developed a treatment algorithm. Patients with symptomatic reflux esophagitis should undergo endoscopy with biopsy. If Barrett's esophagus is diagnosed, an antireflux procedure should be performed, preferably a proximal gastric vagotomy with Nissen's fundoplication. Follow-up examination by endoscopy with biopsy and cytology should be performed every six months. Indications for early esophagectomy include progression of cellular dysplasia, carcinoma in situ, and a non-healing Barrett's ulcer following an antireflux procedure. Our data support an aggressive surgical treatment of patients with Barrett's esophagus.
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000601:surgery*; D004935:Esophageal Diseases / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications; D004947:Esophagus / Q000601:surgery; D005260:Female; D005748:Gastric Fundus / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D014629:Vagotomy, Proximal Gastric