Meta-Analysis for Comparison between Antireflux Surgery With or Without Endoscopic Management of Barrett's Esophagus


The Department of General Surgery, Faculty of Medicine, A in Shams University


Abstract Background: In patients with BE, anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. Endoscopic resection of visible lesions if any, followed by ablation of the rest of the BE epithelium is the current standard of care for management of BE with confirmed dysplasia. Although the current literature describes multiple endoscopic and anti-reflux techniques for the management of BE, there is no published evidence on the efficacy of anti-reflux surgery followed by endoscopic man-agement on the outcomes of BE. Aim of Study: The objective of this study was to compare between anti-reflux surgery with or without endoscopic man-agement of BE. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 6 studies were included. Results: In the present systematic review and meta-analysis, five studies reported the rates of recurrence. The overall effect estimates showed the rate of recurrence was 5.7% (95% CI 1.2-10.2%). In the present systematic review and meta-analysis, five studies reported the overall complica-tions rate. The overall effect estimates showed the overall complications rate was 7.3% (95% CI 4.1-10.6%), mainly stricture and perforation. Conclusion: Endoscopic procedures after anti-reflux surgery is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the manage-ment of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal extent of columnar esophagus.