Barrett's esophagus after resection of the gastroesophageal junction: effects of concomitant fundoplication.

ABSTRACT

BACKGROUND: Barrett's metaplasia has been known to occur after esophagectomy or gastrectomy in which the gastroesophageal junction with its associated lower esophageal sphincter has been resected. It is thought to be secondary to the refluxogenic nature of the operation. The present study was based on the hypothesis that patients who undergo a fundoplication with the resection would have a lower incidence of the development of postoperative Barrett's metaplasia. METHODS: All patients who underwent any type of esophagectomy or proximal gastrectomy in which the gastroesophageal junction was resected and an esophagogastrostomy performed were eligible for the study. Data gathered included age, gender, preoperative diagnosis, operation, postoperative pathology, occurrence and timing of postoperative upper endoscopy, and presence of Barrett's metaplasia on postoperative endoscopy. Statistical analysis was done with Fisher's exact test. RESULTS: Of the 179 patients who underwent resection, 151 had follow-up endoscopy documenting the presence or absence of Barrett's esophagus. Follow-up ranged from 6 months to 10 years. Of the 53 patients without fundoplications, 8 (18%) had Barrett's esophagus on follow-up upper endoscopy. Of the 98 patients with fundoplications, 5 (6%) had Barrett's esophagus (P = 0.04). CONCLUSIONS: The present study suggests that concomitant fundoplication with resection of the gastroesophageal junction may have some protective effect against the development of Barrett's esophagus. A randomized trial will be required to prove this assertion. Also, it is still unclear as to the consequences of the development of post-resection Barrett's esophagus.