Abstract
Background
Background: Barrett’ s esophagus is a complication of severe gastroesophageal reflux disease. The major concern aspect is its association to dysplasia and esophageal adenocarcinoma. Endoscopic surveillance of patients treated surgically or clinically allows early detection of cancer. Aim: Compare clinical and surgical treatment of Barrett's esophagus.
Methods
Methods: from January 1980 to December 2017, 565 patients with Barrett's esophagus were followed up at our service. 214 were submitted to Nissen fundoplication and 221 to clinical treatment with PPI. These 434 patients were submitted to a long follow up with routine endoscopic examination each 2 years with multiple biopsies. The statistical analysis was performed through Fisher's exact test and Propensity score regarding epidemiologic and epithelium data.
Results
Comparing the surgical group (Group A) and the clinical group (Group B), we could observe the development of 11 Adenocarcinoma, 3 in the group A e 8 in group B. Any grade of dysplasia was observed in 9 patients of the group B, and six of them developed adenocarcinoma. The clinical group showed a tendency to develop more adenocarcioma and dysplasia than the surgical group (P = 0.38) and statistically significant increase in the development of dysplasia (P = 0032). 16% of patients in Group A showed progression in Columnar epithelium length against 20% in Group B (ns). 23,4% of the patients in group A keep symptoms and use of PPI, and 28.7 in group B (ns).
Conclusion
In our series as in many recent data in international literature, the surgical treatment for GERd in patients with Barrett's esophagus seems to be a good option to keep the columnar epithelium without progression to dysplasia or adenocarcinoma, with good control of the symptoms and the length of the Barrett's esophagus.
Disclosure
All authors have declared no conflicts of interest.
Cell Proliferation in Esophageal Columnar Epithelium (Barrett’s Esophagus)