Long-term Efficacy of Laparoscopic Antireflux Surgery on Regression of Barrett's Esophagus Using BRAVO Wireless pH Monitoring A Prospective Clinical Cohort Study
Long-term Efficacy of Laparoscopic Antireflux Surgery on Regression of Barrett's Esophagus Using BRAVO Wireless pH Monitoring A Prospective Clinical Cohort Study
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DOI：
10.1097/sla.0000000000002019
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发表时间：
2017-12-01
影响因子：
9
通讯作者：
Thompson, Sarah K.
中科院分区：
文献类型：
--
作者：
Knight, Benjamin C.;Devitt, Peter G.;Thompson, Sarah K.
目的：评估使用BRAVO无线pH监测进行抗反流手术治疗Barrett食管（BE）的长期疗效。背景：BE与慢性胃食管反流和食管癌相关。到目前为止，研究未能证明，防止胃食管反流与抗反流手术停止BE的进展，往往是因为在客观上证明一个有效的antireflux barrier.Methods困难：自1991年以来，所有患者接受抗反流手术在2个医院网站已在一个前瞻性的数据库。确定了抗反流手术后至少随访5年的BE患者。所有患者均完成了临床结局问卷，并对其BE进行了内镜评估和组织学评价。结果：共50例患者（男40例，女10例）纳入研究，平均随访11.9年。大约92%（46/50）的患者报告手术结局为“极好”或“良好”，86%（43/50）的患者报告“无”或“轻度”症状。BE组织学消退率为41%（20/49）。在没有病理学消退的患者中，下食管酸暴露（pH < 4的时间百分比）显著更高（P = 0.008）。此外，64%（32/50）显示内镜下BE长度缩短。内镜下BE减少组的酸暴露也显著减少（%时间pH < 4，0.2 vs 3.6，P = 0.007）。结论：抗反流手术对Barrett食管患者安全有效。BRAVO无线pH监测评估的完整胃底折叠术表明，抗反流手术可能会阻止巴雷特食管的进展，这可能会降低癌症发展的风险。
Objective: To assess the long-term efficacy of antireflux surgery on Barrett's esophagus (BE) using BRAVO wireless pH monitoring.Background: BE is associated with chronic gastroesophageal reflux and esophageal cancer. Till date, studies have failed to demonstrate that preventing gastroesophageal reflux with antireflux surgery halts the progression of BE, often because of difficulties in objectively proving an effective antireflux barrier.Methods: Since 1991, all patients undergoing antireflux surgery across 2 hospital sites have been followed in a prospective database. Patients with BE and at least 5 years follow up after antireflux surgery were identified. All patients completed a clinical outcome questionnaire and underwent endoscopic assessment and histological evaluation of their BE. Fourty-eight hours pH monitoring was then performed with the wireless BRAVO system.Results: A total of 50 patients (40 males: 10 females) were included in the study, with an average follow up of 11.9 years. Approximately, 92% (46/50) reported their outcome of surgery as "excellent'' or "good'' and 86% (43/50) reported "none'' or "mild'' symptoms. Histological regression of BE was seen in 41% (20/49). Lower esophageal acid exposure (percentage time pH < 4) was significantly greater in those with no pathological regression (P = 0.008). Moreover, 64% (32/50) showed endoscopic reduction in the length of BE. Acid exposure was also significantly less in the group showing endoscopic reduction of BE (% time pH < 4, 0.2 vs 3.6, P = 0.007).Conclusions: Antireflux surgery is safe and effective in patients with Barrett's esophagus. An intact fundoplication, as assessed with BRAVO wireless pH monitoring, suggests that antireflux surgery may halt the progression of Barrett's esophagus, and this might reduce the risk of cancer development.