Department of Surgery, University of Chile, Santos Dumont 999, Santiago, Chile.
Obes Surg. 2012 May;22(5):764-72. doi: 10.1007/s11695-011-0531-x.
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.
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.
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.
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.
短节段 Barrett 食管（SSBE）或长节段 Barrett 食管（LSBE）是慢性胃食管反流病（GERD）的后果，而 GERD 常与肥胖相关。肥胖是 GERD 症状、糜烂性食管炎、Barrett 食管和食管腺癌发展的重要危险因素。接受胃旁路手术的病态肥胖患者 GERD 的发病率高达 50%至 100%，Barrett 食管的发病率高达 9%的患者。
在这项前瞻性研究中，我们评估了三种不同手术（校准胃底折叠术+后胃固定术（CFPG）、胃底折叠术+迷走神经切断术+远端胃切除术+Roux-en-Y 胃空肠吻合术（FVDGRYGJ）和腹腔镜切除性 Roux-en-Y 胃旁路术（LRRYGBP））后肥胖患者的术后结果。
在接受 CFPG 的 SSBE 患者中，分别有 15%和 20.2%的患者存在反流症状和内镜下糜烂性食管炎持续存在。LSBE 患者接受 FVDGRYGJ 或 LRRYGBP 治疗后，其症状和糜烂性食管炎明显改善。接受 LRRYGBP 手术的患者，其 LESP 在手术前后均无变化。三种手术均可减少胃酸反流。接受 LRRYGBP 手术的患者，体重指数（BMI）从术前的 41.5±4.3kg/m²降至术后 12 个月的 25.7±1.3kg/m²，显著下降。
在 LSBE 患者中，FVDGRYGJ 在改善 GERD 和 Barrett 食管方面效果非常好，但体重减轻有限。LRRYGBP 改善 GERD 疾病和 Barrett 食管，并证实体重和 BMI 减轻，因此成为肥胖患者的首选手术。
