Long-Term effect of Nissen Fundoplication on Barrett’s Esophagus
Knight BC et al has recently published in the Annals of Surgery an interesting study on the regression of Barrett’s esophagus following laparoscopic Nissen fundoplication surgery for GERD. Since 1991, the authors followed prospectively 50 GERD patients with Barrett’s esophagus who underwent laparoscopic fundoplication. the average post-operative follow up was 12 years. All patients underwent repeat upper endoscopy with biopsies and ambulatory pH testing using the BRAVO system. 41% of patients had complete histologic regression of Barrett’s esophagus, and 64% showed endoscopic reduction in the length of Barrett’s esophagus. In both groups, esophageal acid exposure was significantly lower than patients with no improvement in their Barrett’s esophagus histology or segment length. 92% of patients reported excellent or good surgery outcome.
This study demonstrates the effectiveness, safety and durability of Nissen fundoplication in GERD patients with Barrett’s esophagus. Barrett’s esophagus represents advanced GERD. Barrett’s mucosa ablation and continued PPI use do not address the underlying cause. When properly performed by acid reflux specialists and experts in the field of laparoscopic foregut surgery, Nissen fundoplication remains the most reliable solution for GERD and Barrett’s esophagus.