The effects of laparoscopic Nissen fundoplication on Barrett's esophagus: Long-term results

Abstract

Objective. The aim of our study was to conduct a retrospective investigation of the efficacy of laparoscopic Nissen fundoplication in patients with Barrett's esophagus. Material and methods. A total of 78 patients with Barrett's esophagus underwent surgery. Patients were divided into three groups on the basis of the preoperative endoscopic biopsies: a non-intestinal group (n = 63) with fundic or cardiac metaplasia, an intestinal group (n = 18) with intestinal metaplasia, and a dysplastic group (n = 7) with low-grade dysplasia. Clinical follow-up was available in the case of 64 patients at a mean of 42 ± 16.9 months after surgery. Results. Check-up examination revealed total regression of Barrett's metaplasia in 10 patients. Partial regression was seen in 9 cases, no further progression in 34 patients, and progression into cardiac or intestinal metaplasia in 11 patients. No cases of dysplastic or malignant transformation were registered. Where we observed the regression of BE, among the postoperative functional examinations results of manometry (pressure of lower esophageal sphincter) and pH-metry were significantly better compared with those groups where no changes occurred in BE, or progression of BE was found. Discussion. Our results highlight the importance of the cases of fundic and cardiac metaplasia, which can also transform into intestinal metaplasia. Conclusions. Antireflux surgery can appropriately control the reflux disease in a majority of the patients who had unsuccessful medical treatment, and it may inhibit the progression and induce the regression of Barrett's metaplasia in a significant proportion of these patients.

Key Words::

• antireflux surgery
• Barrett's esophagus
• laparoscopic Nissen fundoplication

Acknowledgement

The authors acknowledge the financial support from the Hungarian Research Fund, OTKA (grant K 73141) for financial support, and 340/09-ETT from the Hungarian Ministry of Social Welfare. Authors would like to thank the cooperation of the members of the South Hungarian Regional Surveillance Group for the Study of Barrett's Esophagus.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.