Anti-reflux surgery for Barrett’s esophagus does not lower risk for esophageal cancer
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Key takeaways:
- There was an overall increased risk for esophageal adenocarcinoma among those in the surgery vs. medication groups.
- The risk increased from 1.8 in the first 1 to 4 years to 4.4 after 10 to 32 years of follow-up.
Patients with Barrett’s esophagus who underwent anti-reflux surgery had an increased risk for esophageal adenocarcinoma over time compared with patients who used anti-reflux medication, according to research.
“Anti-reflux treatment is recommended for patients with Barrett’s esophagus to decrease the risk of esophageal adenocarcinoma,” Johan Hardvik Akerstrom, of the departments of molecular medicine and surgery at Karolinska Institute, and colleagues wrote in Gastroenterology. “Anti-reflux surgery with fundoplication increases the ability of the gastroesophageal anatomical and physiological barrier to prevent reflux and can thus prevent any carcinogenic gastric content from reaching the esophagus, including both acid and bile.”
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They continued: “However, meta-analyses comparing anti-reflux surgery with anti-reflux medication for esophageal adenocarcinoma prevention in patients with Barrett’s esophagus have been inconclusive.”
In a multinational, population-based cohort study, Akerstrom and colleagues investigated the risk for esophageal adenocarcinoma among 33,939 adults with Barrett’s esophagus, who were identified using patient registries in Denmark, Finland, Norway and Sweden. Researchers compared patients who underwent anti-reflux surgery (1.6%) with those who used anti-reflux medication (98.4%).
During 32 years of follow-up, there were 14 new cases of esophageal adenocarcinoma in the surgery group and 437 new cases in the medication group.
Researchers reported an overall increased risk for esophageal adenocarcinoma in the surgery group vs. the medication group (adjusted HR = 1.9; 95% CI, 1.1-3.5), noting this association remained after excluding the first year of follow-up (aHR = 2.7; 95% CI, 1.4-5).
Further, the risk for esophageal adenocarcinoma after surgery “tended to increase” during follow-up, from 1.8 (95% CI, 0.5-5) within the first 1 to 4 years to 4.4 (95% CI, 1.4-13.5) after 10 to 32 years. These results remained consistent after removing patients who underwent endoscopic therapy (aHR = 2.2; 95% CI, 1.2-3.9).
“This multinational and population-based cohort study of patients with Barrett’s esophagus with a long and complete follow-up indicates that patients who undergo anti-reflux surgery do not have a lower risk of esophageal adenocarcinoma than those using anti-reflux medication,” Akerstrom and colleagues concluded. “Instead, patients with Barrett’s esophagus who undergo anti-reflux surgery remain at an increased risk of esophageal adenocarcinoma and should continue taking part in surveillance programs.”
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