Objective: To determine late results of AS-DD procedure in long-segment (LSBE) and extralong-segment BE (ELSBE) using subjective and objective measurements to ascertain the histological impact over intestinal metaplasia (IM) and progression to EAC.
Summary Of Background Data: Barrett esophagus (BE) is a known precursor of esophageal adenocarcinoma (EAC), and Nissen fundoplication has proven to be unable to stop mixed reflux among them. Our group proposed a surgical procedure that handles pathophysiological changes responsible for BE.
Methods: This prospective study included 127 LSBE and ELSBE subjects submitted to clinical and functional analyses. They were presented to selective vagotomy, fundoplication, partial gastrectomy with Roux-en-Y reconstruction. The changes in IM were determined in both groups.
Results: Follow-up was completed at a mean of 18 years in 81% of the cases. Visick I-II scores were seen in 88% of LSBE and 65% in ELSBE ( P < 0.01). There was significant healing of erosive esophagitis and esophageal peptic ulcers, and strictures were resolved in 71%. There was 38% of IM regression in LSBE. Two cases in each group progressed to EAC at a mean of 15 years. Pathologic acid reflux was abolished in 91% and duodenal in 100%. There was a regression of low-grade dysplasia to IM in 80%.
Conclusions: AS-DD permanently eliminates pathologic refluxate to the esophagus. The progression to HGD/EAC is lower compared to medical treatment, with an 8-fold reduction in LSBE and 2.2-fold in ELSBE. AS-DD seems to influence IM behaviors, and it is a tool that could reduce and delay progression to EAC.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/SLA.0000000000004760 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Long-term outcomes after endoscopic eradication therapy for dysplastic and T1a adenocarcinoma related Barrett's esophagus: higher rate of late dysplastic recurrence with radio-frequency ablation monotherapy.
Gastrointest Endosc
January 2025
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia. Electronic address:
Background & Aims: There is conflicting literature describing the durability of complete remission of intestinal metaplasia (CRIM) after endoscopic eradication therapy (EET) for Barrett's esophagus (BE). We aim to assess the timeline, predictors and long-term outcomes of recurrence.
Methods: Data on 365 patients who underwent EET for dysplastic BE were collected prospectively between 2008 and 2022 at a Barrett's referral unit.
Mathematical modeling of somatic evolution, a process impacting both host cells and microbial communities in the human body, can capture important dynamics driving carcinogenesis. Here we considered models for esophageal adenocarcinoma (EAC), a cancer that has dramatically increased in incidence over the past few decades in Western populations, with high case fatality rates due to late-stage diagnoses. Despite advancements in genomic analyses of the precursor Barrett's esophagus (BE), prevention of late-stage EAC remains a significant clinical challenge.
View Article and Find Full Text PDFIntake of fruit, vegetables and pulses, and all-cause, cardiovascular and cancer mortality: Results from a population-based prospective study.
Public Health
January 2025
Department of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Calle de Melchor Fernández Almagro, 5, 28029, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Calle de Melchor Fernández Almagro, 5, 28029, Madrid, Spain. Electronic address:
Objectives: The aim of this study was to explore the association of fruit, vegetable, and pulses consumption with all-cause, cardiovascular, and cancer mortality.
Study Design: This prospective study included 66,933 individuals from three Spanish health surveys linked to the national death registry up to December 2022.
Methods: Adjusted Poisson regression models were used to analyze the data, categorizing fruit, vegetable and pulses intake according to Spanish dietary recommendations and using splines to examine non-linear relationships.
Computer-Assisted Classification of the Squamocolumnar Junction.
Gastrointest Endosc
January 2025
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Electronic address:
Background And Aims: An irregular z-line is characterized by a squamocolumnar junction (SCJ) that extends proximally above the gastroesophageal junction (GEJ) by < 1 centimeter (cm), while Barrett's esophagus (BE) is defined as a columnar lined esophagus (CLE) that extends proximally by ≥1 cm with the presence of specialized intestinal metaplasia (IM) on biopsy. Measurement of CLE is most accurate for lengths ≥1 cm, and as such, guidelines do not recommend biopsy of an irregular z-line when seen on endoscopy. However, a CLE is often estimated by visual inspection rather than direct measurement, making this characterization imprecise.
View Article and Find Full Text PDFInvestigation of causal associations between cerebral cortical structure and Barrett's esophagus: insights from Mendelian randomization and meta-analysis.
J Thorac Dis
December 2024
Surgical Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Background: Barrett's esophagus (BE) is a precancerous condition often associated with esophageal adenocarcinoma, influenced by both genetic and environmental factors. However, there is controversy regarding the causal relationship between cerebral cortical structures and BE, with recent studies suggesting a potential neurobiological component to its multifactorial etiology. This study aims to clarify this relationship by utilizing Mendelian randomization (MR) analysis to investigate the potential causal effects of cortical structure variations on BE risk.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!