Long-term results of classic antireflux surgery in 152 patients with Barrett's esophagus:: Clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation

Background. The classic surgical procedure for patients with Barrett's esophagus (BE) has been either Nissen fundoplication or posterior gastropexy with calibration of the cardia. Methods. The purpose of our study was to determine late subjective and objective results of these classic surgical techniques in a large number of patients with BE. A total of 152 patients were included in this prospective protocol. Results. There was 1 death (0.7%) after operation. The late follow-up of 100 months demonstrated a high percentage of failures among patients with noncomplicated BE (54%) and an even higher figure in patients with complicated BE (64%). In 15 patients low grade dysplasia appeared at 8 years of follow-up and an adenocarcinoma in 4 patients. Twenty-four-hour pH monitoring demonstrated a decrease in acid reflux into the esophagus, and Bilitec studies also demonstrated a decrease of duodeno-esophageal reflux, but in all cases with a higher value than the normal limit. Conclusions. Classic antireflux surgery in patients with BE results in a high percentage of failures at very late follow-up because it cannot completely avoid acid and duodenal reflux into the esophagus.