The effect of laparoscopic fundoplication in therapy of Barrett’s esophagus

René Aujeský; Čestmír Neoral; Radek Vrba; Martin Stašek; Katherine Vomáčková

doi:10.5114/wiitm.2014.41634

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abstract:

Original paper

The effect of laparoscopic fundoplication in therapy of Barrett’s esophagus

René Aujeský

,

Čestmír Neoral

,

Radek Vrba

,

Martin Stašek

,

Katherine Vomáčková

Videosurgery Miniinv 2014; 9 (2): 213–218

DOI: https://doi.org/10.5114/wiitm.2014.41634

Online publish date: 2014/04/01

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Introduction: Barrett’s esophagus is the most significant precancer of the esophagus. Its malignization gives rise to most adenocarcinomas of the esophagus. Therefore selection of adequate therapy for this precancerous condition is of the utmost importance.

Aim: The authors of the work addressed the question of whether effective therapy of reflux disease alone may halt the process of malignization of Barrett’s mucosa or even cause its regression.

Material and methods: The analyzed set comprised 50 patients with Barrett’s esophagus, who in 48 cases underwent laparoscopic fundoplication and in two cases underwent an indirect antireflux procedure in the form of gastric resection with a Roux-en-Y gastrojejunal anastomosis. The effect of the procedure was evaluated by comparing preoperative and postoperative endoscopic examinations, as well as histological analysis by biopsy taken from Barrett’s mucosa.

Results: In 19 patients (38%), Barrett’s mucosa was not detected postoperatively. An improved finding in terms of disappearance of mucosal dysplasia was found in 8 (16%) patients. Findings remained unchanged in 18 (36%) patients. In 5 (10%) patients progression of the disease was discovered.

Conclusions: A surgical antireflux procedure, primarily in the form of laparoscopic fundoplication, is considered an effective method for treating Barrett’s esophagus up to the stage of mild dysplasia. If this therapy is unsuccessful, the method of choice is local therapy, either an endoscopic mucosectomy or radiofrequency ablation.

keywords:

The effect of laparoscopic fundoplication in therapy of Barrett’s esophagus

René Aujeský , Čestmír Neoral , Radek Vrba , Martin Stašek , Katherine Vomáčková

Barrett’s esophagus, esophageal adenocarcinoma, laparoscopic fundoplication

René Aujeský

,

Čestmír Neoral

,

Radek Vrba

,

Martin Stašek

,

Katherine Vomáčková