title: Results of the Collis-Nissen gastroplasty in patients with Barrett's esophagus.
abstract: BACKGROUND
  Barrett's esophagus (BE) is an advanced stage of gastroesophageal reflux disease. Medical treatment and standard antireflux operations show a high failure rate. An elongated gastroplasty, wrapped by a total fundoplication should provide a tension-free repair with adequate protection against reflux. The aim of this study is to review the operative effects of a Collis-Nissen gastroplasty to treat reflux in Barrett's esophagus.
  
  
  METHODS
  From January 1989 to December 1997, 45 patients with BE (38 men, 7 women) aged 53.5 years, underwent a Collis-Nissen gastroplasty. Mean follow-up is 35.9 months (range, 6 to 110 months). Pre- and postoperative evaluations included symptom assessment, esophagogram, endoscopy, manometry, 24-hour pH study, and esophageal emptying scintigrams.
  
  
  RESULTS
  There were no operative deaths. All reflux symptoms were controlled. Acid reflux was significantly reduced (percent time exposure decreased from 10% to 1%) and lower esophageal sphincter (LES) pressure were restored to normal (LES gradient increased from 4 mm Hg to 11 mm Hg). LES incomplete relaxation was noted in 50% of patients postoperatively. Endoscopically, mucosal damage from reflux healed but the columnar mucosa with intestinal metaplasia persisted.
  
  
  CONCLUSIONS
  The Collis-Nissen gastroplasty, in patients with BE, controls reflux disease, its symptoms, and the mucosal damage associated with this condition. It restores the LES gradient but increases the resistance to bolus transit. There is no regression of the abnormal mucosa despite reflux control.
authors.affiliation: Department of Surgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
authors.forename: L Q
authors.initials: LQ
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Nastos
authors.forename: C Y
authors.initials: CY
authors.lastname: Hu
authors.forename: T S
authors.initials: TS
authors.lastname: Chughtai
authors.forename: R
authors.initials: R
authors.lastname: Taillefer
authors.forename: P
authors.initials: P
authors.lastname: Ferraro
authors.forename: A C
authors.initials: AC
authors.lastname: Duranceau
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D011877:Radionuclide Imaging