DESPITE anti-reflux surgery being recommended for patients with Barrett’s oesophagus in order to decrease the risk of later developing oesophageal adenocarcinoma, recent research suggests that it may be no more effective than anti-reflux medication. The study, carried out by Johan Hardvik Åkerström, Karolinska Institutet, Stockholm, Sweden, and Karolinska University Hospital, Solna, Sweden, and colleagues, found that there was an overall increased risk of oesophageal adenocarcinoma over time in patients who underwent surgery as opposed to taking anti-reflux medication.
Previous studies have shown that anti-reflux surgery increases the ability of the gastroesophageal anatomical and physiological barrier to prevent reflux, which in turn prevents any carcinogenic gastric content from reaching the oesophagus. The research team investigated whether this decreases the risk of developing oesophageal adenocarcinoma in adults with Barrett’s oesophagus using a multinational, population-based study. They compared 33,939 patients from registries in Denmark, Finland, Norway, and Sweden, who either underwent anti-reflux surgery (1.6%) or used anti-reflux medication (98.4%). They followed up with the patients for 32 years, comparing the rates of oesophageal cancer in both groups.
The analysis showed that there was an overall higher risk for oesophageal adenocarcinoma in the surgery group versus the medication group (adjusted hazard ratio: 1.9; 95% confidence interval [CI]: 1.4–5.0). Additionally, the team reported that the risk of developing oesophageal cancer tended to increase during follow-up, from 1.8 (95% CI: 0.5–5.0) within the first 1–4 years to 4.4 (95% CI: 1.4–13.5) after 10–32 years. These results remained the same after removing patients who had undergone endoscopic therapy (adjusted hazard ratio: 2.2; 95% CI: 1.2–3.9).
Åkerström and colleagues concluded that those who undergo anti-reflux surgery for Barrett’s oesophagus do not have a decreased risk of oesophageal adenocarcinoma later in life compared with those who use anti-reflux medication. They commented: “Patients with Barrett’s oesophagus who undergo anti-reflux surgery remain at an increased risk of oesophageal adenocarcinoma and should continue taking part in surveillance programmes.”
