Impact of antireflux operation on columnar-lined esophagus.
BACKGROUND
The effect of antireflux operation on the natural history of columnar-lined esophagus (CLE) is not fully understood. The aim of this study was to assess a single center's experience and review the literature on the impact of antireflux operation on CLE without high-grade dysplasia.


METHODS
The medical records of 26 patients with CLE but without high-grade dysplasia who underwent antireflux operation in our unit were retrospectively analyzed at longterm followup with detailed endoscopic investigation. Thirteen patients presented with intestinal metaplasia (6 had short segments, and 1 had preoperative laser ablation) and 13 without intestinal metaplasia. For the group of 13 patients presenting with intestinal metaplasia, the mean endoscopic followup was 74.7 months (median 46 months). Three of six with short-segment lesion and two of seven with circumferential involvement had complete regression of intestinal metaplasia (one after laser therapy). None had progression to dysplasia or carcinoma.


RESULTS
For the group of 13 patients without intestinal metaplasia, mean endoscopic followup was 43.9 months (median 28 months). One had complete regression of CLE, and none developed intestinal metaplasia during surveillance.


CONCLUSIONS
Our study suggests that antireflux operation can alter the natural history of CLE, allowing disease stabilization in a substantial proportion of patients. After antireflux operation, total regression of CLE is possible, but in an unpredictable manner.
Mabrut
Jean-Yves
JY
Department of Digestive Surgery and Liver Transplantation, Croix-Rousse Hospital, Lyon, France.
Baulieux
Jacques
J
Adham
Mustapha
M
De La Roche
Eric
E
Gaudin
Jean-Louis
JL
Souquet
Jean-Christophe
JC
Ducerf
Christian
C
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003938:Diagnostic Techniques, Digestive System; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000517:prevention & control; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies