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A Surgical Entity

Vaughn A. Starnes, MD; R. Benton Adkins, MD; Jeanne F. Ballinger, MD; John L. Sawyers, MD

Arch Surg. 1984;119(5):563-567.

Abstract
• During a ten-year period, endoscopy demonstrated acid-peptic esophagitis in 439 patients. Forty of these patients (9.1%) had Barrett's esophagus. Adenocarcinoma was present in the columnar epithelium in 15 (37.5%) of the patients with Barrett's esophagus. Hiatal hernias, with symptoms of heartburn, dysphagia, stricture, and ulceration, were found in more than 75% of the patients with Barrett's esophagus. We developed a treatment algorithm. Patients with symptomatic reflux esophagitis should undergo endoscopy with biopsy. If Barrett's esophagus is diagnosed, an antireflux procedure should be performed, preferably a proximal gastric vagotomy with Nissen's fundoplication. Follow-up examination by endoscopy with biopsy and cytology should be performed every six months. Indications for early esophagectomy include progression of cellular dysplasia, carcinoma in situ, and a nonhealing Barrett's ulcer following an antireflux procedure. Our data support an aggressive surgical treatment of patients with Barrett's esophagus.

(Arch Surg 1984;119:563-567)

Author Affiliations
From the Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.

Footnotes
Accepted for publication Dec 27, 1983.

Read before the 91st annual meeting of the Western Surgical Association, Monterey, Calif, Nov 15, 1983.

Reprint requests to Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232 (Dr Sawyers).

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