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Clinical Significance of Esophageal Histologic Findings After Antireflux Surgery
Tuomo K. Rantanen, MD;
Jukka T. Salminen, MD;
Judith E. Mäkinen, MD;
Pentti I. Sipponen, MD;
Tuula A. Kiviluoto, MD;
Jarmo A. Salo, MD
Arch Surg. 2001;136:733-736.
Hypothesis Only limited and controversial information exists regarding the histologic effect of successful antireflux surgery on esophageal mucosa and its clinical significance.
Design and Settings A randomized, blinded follow-up study conducted in a university hospital between January 1, 1992, and December 31, 1997, with a mean follow-up of 8 months.
Patients Forty patients with severe symptomatic gastroesophageal reflux disease (24 men and 16 women; mean age, 50 years).
Main Outcome Measures Microscopic signs and severity of esophagitis analyzed by 2 blinded histopathologists.
Results Histopathologist 1 interpreted 22 (69%) of 32 postoperative biopsy specimens as normal; 7 (22%), as showing mild changes; 1 (3%), moderate changes; and 2 (6%), severe changes of reflux esophagitis. Histopathologist 2 interpreted 25 (78%) of 32 postoperative biopsy specimens as normal (P = .001); 1 (3%), as showing mild changes (P = .003); 4 (13%), moderate changes; and 2 (6%), severe changes. Between histopathologist 1 (90.6%) and histopathologist 2 (81%), the absence of esophageal mucosal inflammation correlated best with normalized pH monitoring.
Conclusions These findings suggest that, if other findings such as those from fundic wrap at endoscopy and 24-hour pH monitoring are normal, the clinical significance of routine esophageal histologic examination after successful fundoplication is limited.
From the Departments of Cardiothoracic Surgery (Drs Rantanen, Salminen, Kiviluoto, and Salo) and Pathology (Drs Mäkinen and Sipponen), Helsinki University Central Hospital, Helsinki, Finland.
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