Morrow Ellen, Bushyhead Daniel, Wassenaar Eelco, Hinojosa Marcelo, Loviscek Maximiliano, Pellegrini Carlos, Oelschlager Brant
Division of General Surgery, Department of Surgery, University of Washington, 1959 N.E. Pacific Street, Box 356410, Seattle, WA, 98195-6410, USA,
Surg Endosc. 2014 Dec;28(12):3279-84. doi: 10.1007/s00464-014-3601-z. Epub 2014 Jun 17.
Barrett's esophagus (BE) is a major risk factor for esophageal adenocarcinoma. It is believed that BE is caused by chronic gastro-esophageal reflux disease (GERD). Laparoscopic anti-reflux surgery (LARS) restores the competency of the cardia and may thereby change the natural course of BE. We studied the impact of LARS on the histological profile of BE and on the control of GERD.
We identified all patients with BE who underwent LARS from 1994 to 2007 and contacted them to assess post-operative GERD symptoms via questionnaire. Endoscopy findings, histology, 24 hour pH monitoring, and manometry were also collected using our prospectively maintained database. Histological regression was defined as either loss of dysplasia or disappearance of BE.
Two hundred and fifteen patients met the initial inclusion criteria; in 82 of them histology from post-operative endoscopy was available for review. Endoscopy was performed a median of 8 years (range, 1-16 years) after surgery. Regression of BE occurred in 18 (22%) patients while in 6 (7%) BE progressed to dysplasia or cancer. Thirty-six (43%) patients underwent pre- and post-operative manometry. The median lower esophageal sphincter pressure increased from 9 to 17 mmHg in these patients. Thirty-four (41%) patients underwent pre- and post-operative pH studies. The median DeMeester score decreased from 54 to 9. Sixty-seven (82%) of 82 patients completed the post-operative questionnaire; 86% of these patients reported improvement in heartburn and regurgitation.
LARS was associated with both physiologic and symptomatic control of GERD in patients with BE. LARS resulted in regression of BE in 22% of patients and progression in 7%. Thus, continued surveillance of Barrett's is needed after LARS.
巴雷特食管（BE）是食管腺癌的主要危险因素。人们认为BE是由慢性胃食管反流病（GERD）引起的。腹腔镜抗反流手术（LARS）可恢复贲门功能，从而可能改变BE的自然病程。我们研究了LARS对BE组织学特征及GERD控制的影响。
我们确定了1994年至2007年期间接受LARS的所有BE患者，并通过问卷调查与他们联系以评估术后GERD症状。还使用我们前瞻性维护的数据库收集了内镜检查结果、组织学、24小时pH监测和测压数据。组织学消退定义为异型增生消失或BE消失。
215名患者符合初始纳入标准；其中82名患者术后内镜检查的组织学结果可供审查。术后内镜检查的中位时间为术后8年（范围1 - 16年）。18名（22%）患者的BE发生消退，而6名（7%）患者的BE进展为异型增生或癌症。36名（43%）患者进行了术前和术后测压。这些患者的食管下括约肌压力中位数从9 mmHg增加到17 mmHg。34名（41%）患者进行了术前和术后pH研究。DeMeester评分中位数从54降至9。82名患者中有67名（82%）完成了术后问卷调查；其中86%的患者报告烧心和反流症状有所改善。
LARS与BE患者GERD的生理和症状控制相关。LARS使22%的患者BE消退，7%的患者BE进展。因此，LARS术后仍需继续监测巴雷特食管。
