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Is There a Role for the Surgeon in the Therapeutic Management of Barrett’s Esophagus?

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Revisiting Barrett's Esophagus

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Abstract

Gastroesophageal reflux disease (GERD) is an evidence-based major risk factor for the development of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EA). Antireflux surgery (ARS) may offer more complete reflux inhibition than does medical treatment, because surgery also mechanically prevents duodeno-gastro-esophageal reflux. Theoretically, ARS could reduce the risk of progression for patients with BE to EA or even lead to a regression of BE and/or dysplasia.

A thorough review of the current literature suggests that regression of BE including low grade dysplasia occurs more frequently after ARS than medical treatment however, this effect is predominantly limited to short segment Barrett’s esophagus.

To date, publications including a recent systematic review have failed to demonstrate a clear consistent benefit of ARS in reducing the risk of EA compared to medical therapy. These publications have been limited by small sample sizes and poorly defined control populations specifically regarding the severity of reflux. Interestingly, the actual results of the English national population-based cohort study including 580,293 patients with GERD showed that in BE patients, ARS reduced the risk of EA (HR = 0.44; 95%CI 0.06–3.04) however, without reaching statistical significance. ARS may therefore be associated with a reduced esophageal cancer risk but still remains primarily an operation for symptomatic relief. New therapeutic options combining ablation techniques as radiofrequency ablation or endoscopic mucosal resection with ARS appear attractive but need further evaluation in large prospective trials.

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Authors and Affiliations

  1. General Surgery 2 Unit, ASST Spedali Civili, Brescia, Italy

    Uberto Fumagalli Romario

  2. Department of Visceral, Thoracic, and Vascular Surgery, City of Zurich-Triemli Hospital, Zurich, Switzerland

    Paul Magnus Schneider

  3. Department of Visceral, Thoracic, and specialized Tumor Surgery, Visceral Oncology Tumor Center, Hirslanden Medical Center, Zurich, Switzerland

    Paul Magnus Schneider

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  1. Uberto Fumagalli Romario
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  1. Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy

    Giuseppe Galloro

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Romario, U.F., Schneider, P.M. (2019). Is There a Role for the Surgeon in the Therapeutic Management of Barrett’s Esophagus?. In: Galloro, G. (eds) Revisiting Barrett's Esophagus. Springer, Cham. https://doi.org/10.1007/978-3-319-92093-1_18

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  • DOI: https://doi.org/10.1007/978-3-319-92093-1_18

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