Effect of duodenal diversion on low-grade dysplasia in patients with Barrett's esophagus: Analysis of 37 patients

Abstract

It is well known that in patients with Barrett's esophagus (BE), even after antireflux surgery, intestinal metaplasia can progress to dysplasia or even adenocarcinoma. However, the opposite - that is regression of dysplastic changes to intestinal metaplasia after antireflux surgery - has been documented in only a few reports. The objective of this study was to determine the effect of a duodenal diversion operation on low-grade dysplasia in patients with BE. Thirty-seven patients with either short-segment (n = 12) or long-segment (n = 25) BE underwent antireflux surgery plus either a duodenal switch procedure (13 patients) or a partial distal gastrectomy with Roux-en-Y gastrojejunal anastomosis (24 patients). All of them were subjected to complete clinical, endoscopic, histologic, manometric, and 24-hour pH testing, and 24-hour monitoring of the bile exposure in distal esophagus. There were no deaths in this series, and morbidity occurred in only one patient (2.7%). Manometric assessmen