title: Long-term follow-up after anti-reflux surgery in patients with Barrett's esophagus.
abstract: BACKGROUND
  Factors associated with the risk of progression of Barrett's esophagus remain unclear, and the impact of therapy on this risk remains uncertain. The aim of this study was to assess patients followed long-term after anti-reflux surgery for Barrett's esophagus.
  
  
  METHODS
  A retrospective review was performed of all patients with Barrett's who underwent anti-reflux surgery from 1989 to 2009 and had ≥5 years of follow-up.
  
  
  RESULTS
  There were 303 patients and 75 had follow-up ≥5 years. Median follow-up time for the 75 patients was 8.9 years (range 5-18). Regression was seen in 31%. Progression occurred in 8%, and these patients were significantly more likely to have a failed fundoplication (67% vs. 16%, p = 0.0129). The rate of progression from non-dysplastic Barrett's to high-grade dysplasia or cancer was 0.8% per patient year, and was seven times higher in patients with a failed fundoplication.
  
  
  CONCLUSIONS
  Compared to the accepted rate of progression of non-dysplastic Barrett's to high-grade dysplasia or cancer of 1.0% per patient year, anti-reflux surgery reduces this rate during long-term follow-up. The rate of progression was significantly lower in patients with an intact compared to a disrupted fundoplication, further suggesting that anti-reflux surgery can alter the natural history of Barrett's esophagus.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: Shahin
authors.initials: S
authors.lastname: Ayazi
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Costales
authors.forename: Florian
authors.initials: F
authors.lastname: Augustin
authors.forename: Arzu
authors.initials: A
authors.lastname: Oezcelik
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Sohn
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hagen
authors.forename: Tom R
authors.initials: TR
authors.lastname: DeMeester
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000601:surgery*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
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