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A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients.
Ann Surg 1997; 226(2):123-33AnnS

Abstract

OBJECTIVE

To determine the results of a new surgical procedure for patients with Barrett's esophagus.

SUMMARY BACKGROUND DATA

In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients.

METHODS

Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length.

RESULTS

No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients.

CONCLUSIONS

This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.

Authors+Show Affiliations

Department of Surgery, University Hospital, Santiago, Chile.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9296504

Citation

Csendes, A, et al. "A New Physiologic Approach for the Surgical Treatment of Patients With Barrett's Esophagus: Technical Considerations and Results in 65 Patients." Annals of Surgery, vol. 226, no. 2, 1997, pp. 123-33.
Csendes A, Braghetto I, Burdiles P, et al. A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients. Ann Surg. 1997;226(2):123-33.
Csendes, A., Braghetto, I., Burdiles, P., Díaz, J. C., Maluenda, F., & Korn, O. (1997). A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients. Annals of Surgery, 226(2), pp. 123-33.
Csendes A, et al. A New Physiologic Approach for the Surgical Treatment of Patients With Barrett's Esophagus: Technical Considerations and Results in 65 Patients. Ann Surg. 1997;226(2):123-33. PubMed PMID: 9296504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients. AU - Csendes,A, AU - Braghetto,I, AU - Burdiles,P, AU - Díaz,J C, AU - Maluenda,F, AU - Korn,O, PY - 1997/8/1/pubmed PY - 1997/9/20/medline PY - 1997/8/1/entrez SP - 123 EP - 33 JF - Annals of surgery JO - Ann. Surg. VL - 226 IS - 2 N2 - OBJECTIVE: To determine the results of a new surgical procedure for patients with Barrett's esophagus. SUMMARY BACKGROUND DATA: In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients. METHODS: Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length. RESULTS: No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients. CONCLUSIONS: This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/9296504/A_new_physiologic_approach_for_the_surgical_treatment_of_patients_with_Barrett's_esophagus:_technical_considerations_and_results_in_65_patients_ L2 - http://Insights.ovid.com/pubmed?pmid=9296504 DB - PRIME DP - Unbound Medicine ER -