Impact of antireflux surgery on Barrett's esophagus.
OBJECTIVE
The rising incidence of Barrett's carcinoma is a matter of major concern in Western societies. We realized a review of the literature to evaluate the impact of antireflux surgery on prevention of Barrett's carcinoma.


METHODS
We used MedLine- and PubMed-based review of the literature published since 1970 on surgical treatment of Barrett's esophagus.


RESULTS
There is no report in the literature that describes de novo development of Barrett's metaplasia after successful antireflux surgery. Compared with medical therapy, the risk for malignant degeneration of Barrett's metaplasia is reduced in surgical patients according to some studies. On the other hand, regression of Barrett's metaplasia after antireflux surgery is rare and Barrett's carcinoma after surgery has been observed repeatedly. The combination of antireflux surgery and ablation of metaplastic mucosa in order to obtain regression has led to encouraging preliminary results; however, experience is still limited and numerous studies currently are underway. Dysplastic Barrett's esophagus (BE) is a precancerosis and should not be treated as BE without dysplasia; strategies other than antireflux surgery need to be discussed.


CONCLUSIONS
A prophylactic effect of early antireflux surgery upon de novo development of Barrett's metaplasia is probable. The impact of surgery on malignant degeneration of Barrett's epithelium remains uncertain. Data currently available show no clear benefit of antireflux surgery on cancerogenesis in patients with Barrett's metaplasia.
Gutschow
Christian A
CA
Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50931 Cologne, Germany. ch.gutschow@t-online.de
Schröder
Wolfgang
W
Prenzel
Klaus
K
Bollschweiler
Elfriede
E
Romagnoli
Renato
R
Collard
Jean-Marie
JM
Hölscher
Arnulf H
AH
D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000517:prevention & control; D004945:Esophagoscopy; D018662:Fundoplication / Q000009:adverse effects / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D011230:Precancerous Conditions / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome