Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus

BACKGROUND: Columnar-lined esophagus with intestinal metaplasia (IM), also called Barrett's esophagus, is a manifestation of severe gastroesophageal r eflux (GER) and may predict poor symptom relief and high failure rate after fundoplication. We compared symptom scores and reoperation rates in GER pa tients with and without Barrett's esophagus. METHODS: Between July 1992 and July 1997, 646 patients underwent fundoplica tion (626 laparoscopic). Of 150 endoscopic biopsies of suspected columnar-l ined esophagus, 80 confirmed IM, 50 identified cardiac or fundic epithelium , and 20 revealed only esophagitis. Typical GER symptoms were scored by pat ients preoperatively and postoperatively (0 to 4 scale). We compared sympto m response (Wilcoxon rank sum test) and failure rates (t test) in patients with IM and GER controls without IM. Preoperative data were available for 7 4 IM patients and 496 controls. One-year follow-up was available in 45 IM p atients and 301 controls. Intermediate follow-up (2 to 5 years) was availab le in 20 IM patients and 99 controls. RESULTS: Preoperatively and postoperatively, patients with IM reported hear tburn, regurgitation, and dysphagia scores similar to controls. Procedure f ailure, requiring redo fundoplication, appeared more likely in IM patients than controls (6.3% versus 2.5%), but this difference did not reach statist ical significance (P = 0.061). CONCLUSION: Fundoplication provides equivalent symptom relief for patients with and without IM. Am J Surg. 1999;178:18-21, (C) 1999 by Excerpta Medica , Inc.