Long-term follow-up after anti-reflux surgery in patients with Barrett's esophagus.
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.
Zehetner
Joerg
J
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
DeMeester
Steven R
SR
Ayazi
Shahin
S
Costales
Jesse L
JL
Augustin
Florian
F
Oezcelik
Arzu
A
Lipham
John C
JC
Sohn
Helen J
HJ
Hagen
Jeffrey A
JA
DeMeester
Tom R
TR
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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