title: Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett's esophagus: a prospective study.
abstract: BACKGROUND
  Short-segment Barrett's esophagus (SSBE) or long-segment Barrett's esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett's esophagus reaches up to 9% of patients.
  
  
  METHODS
  In this prospective study, we evaluate the postoperative results after three different procedures--calibrated fundoplication + posterior gastropexy (CFPG), fundoplication + vagotomy + distal gastrectomy + Roux-en-Y gastrojejunostomy (FVDGRYGJ), and laparoscopic resectional Roux-en-Y gastric bypass (LRRYGBP)--among obese patients.
  
  
  RESULTS
  In patients with SSBE who submitted to CFPG, the persistence of reflux symptoms and endoscopic erosive esophagitis was observed in 15% and 20.2% of them, respectively. Patients with LSBE were submitted to FVDGRYGJ or LRRYGBP which significantly improved their symptoms and erosive esophagitis. No modifications of LESP were observed in patients who submitted to LRRYGBP before or after the operation. Acid reflux diminished after the three types of surgery were employed. Patients who submitted to LRRYGBP presented a significant reduction of BMI from 41.5 ± 4.3 to 25.7 ± 1.3 kg/m(2) after 12 months.
  
  
  CONCLUSIONS
  Among patients with LSBE, FVDGRYGJ presents very good results in terms of improving GERD and Barrett's esophagus, but the reduction of weight is limited. LRRYGBP improves GERD disease and Barrett's esophagus with proven reduction in body weight and BMI, thus becoming the procedure of choice for obese patients.
authors.affiliation: Department of Surgery, University of Chile, Santos Dumont 999, Santiago, Chile. ibraghet@redclinicauchile.cl
authors.forename: Italo
authors.initials: I
authors.lastname: Braghetto
authors.forename: Owen
authors.initials: O
authors.lastname: Korn
authors.forename: Attila
authors.initials: A
authors.lastname: Csendes
authors.forename: Luis
authors.initials: L
authors.lastname: Gutiérrez
authors.forename: Héctor
authors.initials: H
authors.lastname: Valladares
authors.forename: Max
authors.initials: M
authors.lastname: Chacon
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D001471:Barrett Esophagus / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology; D059485:Gastropexy / Q000379:methods; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014628:Vagotomy / Q000379:methods