Minia University Hospital, Minia, Egypt.
Saudi J Gastroenterol. 2011 May-Jun;17(3):185-8. doi: 10.4103/1319-3767.80381.
BACKGROUND/AIM: Laparoscopic fundoplication can alter the natural course of Barrett's esophagus (BE). This study was undertaken to assess this role in patients with non-complicated BE.
From October 2004 to October 2009, 43 patients with BE (32 men and 11 women) underwent laparoscopic Nissen fundoplication surgery in the Department of Surgery at Minia University Hospital. The median age of these patients was 46 years (range: 22-68 years). Patients with high-grade dysplasia, invasive cancer, or previous antireflux surgery were excluded. All 43 patients had gastroesophageal reflux symptoms. Heartburn was present in all patients, regurgitation in 41 (95.3%), dysphagia in 8 (18.6%), retrosternal pain in 30 (69.8%), upper gastrointestinal hemorrhage in 6 (13.9%), and respiratory symptoms in 19 (44.2%). Nissen fundoplication was performed in all patients. Thirty-four patients (79.1%) had concomitant hiatal hernia and nine patients (20.9%) had low-grade dysplasia.
The median follow-up period was 25.6 months. There was significant improvement of symptoms after surgery (P<0.05). Eight (18.6%) of those with short-segment BE had total regression and four (9.3%) of those with long-segment BE had a decrease in total length. Among the nine patients with preoperative low-grade dysplasia, dysplasia disappeared in seven, remained unchanged in one, and progressed to in situ adenocarcinoma in one patient.
laparoscopic fundoplication succeeded in controlling symptoms but had unpredictable effect on dysplasia and regression of BE. Laparoscopic fundoplication does not eliminate the risk of developing esophageal adenocarcinoma and therefore, endoscopic follow-up should be continued in these patients.
背景/目的：腹腔镜胃底折叠术可以改变 Barrett 食管（BE）的自然病程。本研究旨在评估该术式在非复杂性 BE 患者中的作用。
2004 年 10 月至 2009 年 10 月，在米尼亚大学医院外科，43 例 BE 患者（32 名男性和 11 名女性）接受了腹腔镜 Nissen 胃底折叠术。这些患者的中位年龄为 46 岁（范围：22-68 岁）。排除高级别异型增生、浸润性癌或既往抗反流手术的患者。所有 43 例患者均有胃食管反流症状。所有患者均存在烧心，41 例（95.3%）存在反流，8 例（18.6%）存在吞咽困难，30 例（69.8%）存在胸骨后疼痛，6 例（13.9%）存在上消化道出血，19 例（44.2%）存在呼吸症状。所有患者均行 Nissen 胃底折叠术。34 例（79.1%）患者合并食管裂孔疝，9 例（20.9%）患者存在低级别异型增生。
中位随访时间为 25.6 个月。术后症状明显改善（P<0.05）。8 例（18.6%）短节段 BE 患者完全消退，4 例（9.3%）长节段 BE 患者总长度减少。9 例术前低级别异型增生患者中，7 例异型增生消失，1 例无变化，1 例进展为原位腺癌。
腹腔镜胃底折叠术成功控制了症状，但对异型增生和 BE 消退的影响不可预测。腹腔镜胃底折叠术并不能消除发展为食管腺癌的风险，因此，这些患者应继续进行内镜随访。
