title: The effect of laparoscopic fundoplication in therapy of Barrett's esophagus.
abstract: BACKGROUND
  Barrett's esophagus is the most significant precancer of the esophagus. Its malignization gives rise to most adenocarcinomas of the esophagus. Therefore selection of adequate therapy for this precancerous condition is of the utmost importance.
  
  
  OBJECTIVE
  The authors of the work addressed the question of whether effective therapy of reflux disease alone may halt the process of malignization of Barrett's mucosa or even cause its regression.
  
  
  METHODS
  The analyzed set comprised 50 patients with Barrett's esophagus, who in 48 cases underwent laparoscopic fundoplication and in two cases underwent an indirect antireflux procedure in the form of gastric resection with a Roux-en-Y gastrojejunal anastomosis. The effect of the procedure was evaluated by comparing preoperative and postoperative endoscopic examinations, as well as histological analysis by biopsy taken from Barrett's mucosa.
  
  
  RESULTS
  In 19 patients (38%), Barrett's mucosa was not detected postoperatively. An improved finding in terms of disappearance of mucosal dysplasia was found in 8 (16%) patients. Findings remained unchanged in 18 (36%) patients. In 5 (10%) patients progression of the disease was discovered.
  
  
  CONCLUSIONS
  A surgical antireflux procedure, primarily in the form of laparoscopic fundoplication, is considered an effective method for treating Barrett's esophagus up to the stage of mild dysplasia. If this therapy is unsuccessful, the method of choice is local therapy, either an endoscopic mucosectomy or radiofrequency ablation.
authors.affiliation: First Department of Surgery, Palacký University Teaching Hospital, Olomouc, Czech Republic.
authors.forename: René
authors.initials: R
authors.lastname: Aujeský
authors.affiliation: First Department of Surgery, Palacký University Teaching Hospital, Olomouc, Czech Republic.
authors.forename: Cestmír
authors.initials: C
authors.lastname: Neoral
authors.affiliation: First Department of Surgery, Palacký University Teaching Hospital, Olomouc, Czech Republic.
authors.forename: Radek
authors.initials: R
authors.lastname: Vrba
authors.affiliation: First Department of Surgery, Palacký University Teaching Hospital, Olomouc, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Stašek
authors.affiliation: First Department of Surgery, Palacký University Teaching Hospital, Olomouc, Czech Republic.
authors.forename: Katherine
authors.initials: K
authors.lastname: Vomáčková
keywords: Barrett's esophagus; esophageal adenocarcinoma; laparoscopic fundoplication
references.citation: Gut. 2001 Mar;48(3):304-9
references.pmid: 11171817
references.citation: Ann Thorac Surg. 2004 Nov;78(5):1777-82
references.pmid: 15511474
references.citation: Br J Surg. 1988 Jun;75(6):540-3
references.pmid: 3395818
references.citation: J Gastrointest Surg. 2008 Oct;12(10):1646-54; discussion 1654-5
references.pmid: 18709511
references.citation: Am J Gastroenterol. 2007 Jan;102(1):10-20
references.pmid: 17266684
references.citation: Ann Thorac Surg. 2008 Jan;85(1):251-6
references.pmid: 18154819
references.citation: Minerva Chir. 2011 Feb;66(1):1-6
references.pmid: 21389920
references.citation: Gut. 2001 Mar;48(3):310-3
references.pmid: 11171818
references.citation: Semin Thorac Cardiovasc Surg. 2005 Winter;17(4):320-5
references.pmid: 16428038
references.citation: Rozhl Chir. 2007 Sep;86(9):490-2
references.pmid: 17974142
references.citation: Wideochir Inne Tech Maloinwazyjne. 2013 Jun;8(2):107-11
references.pmid: 23837094
references.citation: Surgery. 2012 Mar;151(3):382-90
references.pmid: 22019500
references.citation: Surgery. 1957 Jun;41(6):881-94
references.pmid: 13442856
references.citation: Am J Gastroenterol. 2005 Mar;100(3):551-9
references.pmid: 15743351