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Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus

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Abstract

Objective

HALO radiofrequency ablation (RFA) has been proven as safe and efficient in eradication of both non- and dysplastic Barrett’s esophagus (BE). Definitive post-RFA treatment is yet to be determined.

Methods

RFA was performed in 56 patients with BE, 38 with intestinal metaplasia (IM) and 18 with low-grade dysplasia (LGD), and repeated in case of residual BE. Length of the BE was classified according to C&M criteria. Follow-up included regular upper GI endoscopies with biopsies 6 months, 1 and 2 years after the complete resolution of BE. Patients were divided into two groups regarding post-RFA treatment: those maintaining proton pump inhibitors (PPI) daily and those submitted to laparoscopic Nissen fundoplication (LNF) at least 3 months after BE eradication or synchronous with RFA.

Results

There were no perforations or strictures related to RFA. Complete endoscopic resolution of BE was observed in 83.92 % patients (86.84 % IM and 77.77 % LGD), in 25 that maintained PPI and 22 in whom LNF was done. In PPI group, 2-year follow-up revealed BE recurrence in biopsy samples in 20 % of patients, while in LNF group 9.1 % of patients had recurrent IM. In overall sample of patients, no difference was noted regarding the influence of post-RFA treatment (p < 0.423). LNF proved superiority over PPI treatment in patients with long-segment BE (cutoff C > 4 cm, p < 0.021).

Conclusion

HALO RFA is a safe procedure, with high rate of success in complete eradication of BE in symptomatic GERD patients. LNF provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first line of treatment after HALO RFA.

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Authors and Affiliations

  1. Department of Esophageal Surgery, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Koste Todorovica St 6, Belgrade, 11 000, Serbia

    Ognjan Skrobić, Aleksandar Simić, Nebojša Radovanović, Nenad Ivanović & Predrag Peško

  2. Department of Digestive Pathology, Clinical Center of Serbia, School of Medicine, First Surgical University Hospital, University of Belgrade, Belgrade, Serbia

    Marjan Micev

Authors
  1. Ognjan Skrobić
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  2. Aleksandar Simić
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  3. Nebojša Radovanović
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  4. Nenad Ivanović
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  5. Marjan Micev
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  6. Predrag Peško
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Correspondence to Ognjan Skrobić.

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Ognjan Skrobic, Aleksandar Simić, Nebojsa Radovanovic, Nenad Ivanovic, Marjan Micev and Predrag Pesko have no conflicts of interest or financial ties to disclose.

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Skrobić, O., Simić, A., Radovanović, N. et al. Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett’s esophagus. Surg Endosc 30, 3802–3807 (2016). https://doi.org/10.1007/s00464-015-4677-9

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  • DOI: https://doi.org/10.1007/s00464-015-4677-9

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