title: Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett's esophagus.
abstract: HALO radiofrequency ablation (RFA) has been proven as safe and efficient in eradication of both non- and dysplastic Barrett's esophagus (BE). Definitive post-RFA treatment is yet to be determined.
  
  
  
  RFA was performed in 56 patients with BE, 38 with intestinal metaplasia (IM) and 18 with low-grade dysplasia (LGD), and repeated in case of residual BE. Length of the BE was classified according to C&M criteria. Follow-up included regular upper GI endoscopies with biopsies 6 months, 1 and 2 years after the complete resolution of BE. Patients were divided into two groups regarding post-RFA treatment: those maintaining proton pump inhibitors (PPI) daily and those submitted to laparoscopic Nissen fundoplication (LNF) at least 3 months after BE eradication or synchronous with RFA.
  
  
  
  There were no perforations or strictures related to RFA. Complete endoscopic resolution of BE was observed in 83.92 % patients (86.84 % IM and 77.77 % LGD), in 25 that maintained PPI and 22 in whom LNF was done. In PPI group, 2-year follow-up revealed BE recurrence in biopsy samples in 20 % of patients, while in LNF group 9.1 % of patients had recurrent IM. In overall sample of patients, no difference was noted regarding the influence of post-RFA treatment (p < 0.423). LNF proved superiority over PPI treatment in patients with long-segment BE (cutoff C > 4 cm, p < 0.021).
  
  
  
  HALO RFA is a safe procedure, with high rate of success in complete eradication of BE in symptomatic GERD patients. LNF provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first line of treatment after HALO RFA.
authors.affiliation: Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia. skrobico@gmail.com.
authors.forename: Ognjan
authors.initials: O
authors.lastname: Skrobić
authors.affiliation: Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Simić
authors.affiliation: Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia.
authors.forename: Nebojša
authors.initials: N
authors.lastname: Radovanović
authors.affiliation: Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Ivanović
authors.affiliation: Department of Digestive Pathology, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Belgrade, Serbia.
authors.forename: Marjan
authors.initials: M
authors.lastname: Micev
authors.affiliation: Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Peško
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D054328:Proton Pump Inhibitors
keywords: Barrett’s esophagus; Laparoscopic Nissen fundoplication; Radiofrequency ablation