Dunn Colin P, Henning Justin C, Sterris Jason A, Won Paul, Houghton Caitlin, Bildzukewicz Nikolai A, Lipham John C
The Division of Upper GI and General Surgery at the University of Southern California, Los Angeles, CA, USA.
Hoag Memorial Hospital Presbyterian Digestive Health Institute, Newport Beach, CA, USA.
Surg Endosc. 2021 Oct;35(10):5804-5809. doi: 10.1007/s00464-020-08074-6. Epub 2020 Oct 8.
Untreated gastroesophageal reflux disease (GERD) can lead to Barrett's esophagus and an increased risk for esophageal adenocarcinoma. Magnetic sphincter augmentation (MSA) is a safe and effective modality for the treatment of GERD. Preliminary research on short-term outcomes after MSA demonstrated significant regression of Barrett's. Further investigation is required to evaluate the long-term effect of this treatment.
A retrospective review of patients was conducted with biopsy-proven Barrett's esophagus who underwent MSA between 2007 and 2019. As a part of their preoperative evaluation, patients underwent esophagogastroduodenoscopy (EGD) with biopsies of the distal esophagus and gastroesophageal junction including any abnormal-appearing segments, pH testing, and a videoesophagram. Patients were categorized according to the length of Barrett's identified (ultrashort < 1 cm, short 1-3 cm, long > 3 cm). Improvement was defined as a decrease in length (e.g. long to short).
There were 87 patients identified for study inclusion. 55 patients were male. The median body mass index was 26.95. The median age was 61.81 (49.79-68.29). Mean follow-up time was 2.35 ± (1.57) years. 7 (8.0%) of these patients began with long segment Barrett's, 58 (66.7%) began with short segment disease, and 22 (25.3%) began with an ultrashort segment. Within this cohort, 74 (85.06%) had undergone postoperative biopsy. 7 out of 74 patients (9.46%) showed improvement in their intestinal metaplasia and 45/74 (60.81%) showed complete regression. Fisher's exact test showed a significant decrease in Barrett's length following MSA (p = 0.002). No patients progressed to dysplasia or neoplasia. There was a statistically significant decrease in the median Demeester score from 34.00 to 13.70 after surgery (p < .001).
MSA reduces esophageal acid exposure and can lead to reduction or resolution of Barrett's esophagus. MSA is also effective at preventing progression of metaplasia to dysplasia or neoplasia. This effect remains consistent even after 2 years of follow-up.
未经治疗的胃食管反流病（GERD）可导致巴雷特食管，并增加食管腺癌的风险。磁括约肌增强术（MSA）是一种治疗GERD的安全有效的方法。MSA术后短期疗效的初步研究表明巴雷特食管有显著消退。需要进一步研究来评估这种治疗的长期效果。
对2007年至2019年间接受MSA治疗且活检证实为巴雷特食管的患者进行回顾性研究。作为术前评估的一部分，患者接受了食管胃十二指肠镜检查（EGD），对远端食管和胃食管交界处进行活检，包括任何外观异常的节段，进行pH检测和视频食管造影。根据所确定的巴雷特食管长度对患者进行分类（超短段＜1cm，短段1 - 3cm，长段＞3cm）。改善定义为长度减少（例如从长段变为短段）。
共确定87例患者纳入研究。55例为男性。中位体重指数为26.95。中位年龄为61.81（49.79 - 68.29）。平均随访时间为2.35±（1.57）年。这些患者中，7例（8.0%）开始为长段巴雷特食管，58例（66.7%）开始为短段疾病，22例（25.3%）开始为超短段。在这个队列中，74例（85.06%）接受了术后活检。74例患者中有7例（9.46%）肠化生有改善，45/74例（60.81%）完全消退。费舍尔精确检验显示MSA术后巴雷特食管长度显著缩短（p = 0.002）。没有患者进展为发育异常或肿瘤形成。术后中位德梅斯特评分从34.00显著降至13.70（p＜0.001）。
MSA可减少食管酸暴露，并可导致巴雷特食管缩小或消退。MSA还能有效预防化生进展为发育异常或肿瘤形成。即使在随访2年后，这种效果仍然持续。
