The Durability of Endoscopic Therapy for Treatment of Barrett's Metaplasia, Dysplasia, and Mucosal Cancer After Nissen Fundoplication.
BACKGROUND
Radiofrequency ablation (RFA) ± endoscopic resection (EMR) is an established treatment strategy for neoplastic Barrett's and intramucosal cancer. Most patients are managed with proton pump inhibitors. The incidence of recurrent Barrett's metaplasia, dysplasia, or cancer after complete eradication is up to 43 % using this strategy. We hypothesize the addition of fundoplication should result in a lower recurrence rates after complete eradication.


METHODS
Multi-institutional retrospective review of patients undergoing endotherapy followed by Nissen fundoplication


RESULTS
A total of 49 patients underwent RFA ± EMR followed by Nissen fundoplication. Complete remission of intestinal metaplasia (CR-IM) was achieved in 26 (53 %) patients, complete remission of dysplasia (CR-D) in 16 (33 %) patients, and 7 (14 %) had persistent neoplastic Barrett's. After fundoplication, 18/26 (70 %) remained in CR-IM. An additional 10/16 CR-D achieved CR-IM and 4/7 with persistent dysplasia achieved CR-IM. One patient progressed to LGD while no patient developed HGD or cancer.


CONCLUSIONS
Endoscopic therapy for Barrett's dysplasia and/or intramucosal cancer followed by fundoplication results in similar durability of CR-IM to patients being managed with PPIs alone after endoscopic therapy. However, fundoplication may be superior in preventing further progression of disease and the development of cancer. Fundoplication is an important strategy to achieve and maintain CR-IM, and facilitate eradication of persistent dysplasia.
Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Suite 900, 1101 Madison Street, Seattle, WA, 98105, USA.
Corey S
CS
Johnson
Brian E
BE
Louie
Aaron
A
Wille
Christy M
CM
Dunst
Stephanie G
SG
Worrell
Steven R
SR
DeMeester
Jessica
J
Reynolds
Joe
J
Dixon
John C
JC
Lipham
Michal
M
Lada
Jeffrey H
JH
Peters
Thomas J
TJ
Watson
Alexander S
AS
Farivar
Ralph W
RW
Aye
D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011230:Precancerous Conditions; D012189:Retrospective Studies; D016896:Treatment Outcome