P1.002. Twenty Years Follow-Up in Barrett's Esophagus: Does Fundoplication Demonstrate Superiority in the Comprehensive Long-Term Control of the Disease?

Abstract

Abstract Topic Benign Disease: Barrett’s Esophagus: Pathology and Pathophysiology; Non-invasive Neoplasia Background The study analyzed the long-term evolution of Barrett's Esophagus (BE) and the effectiveness of clinical and surgical treatments for Gastroesophageal Reflux Disease (GERD), aiming to optimize the management of the condition and its progression risks. Objectives: (1) To characterize the BE patient population under outpatient follow-up, describing demographic data, anthropometrics, habits, and initial endoscopic and histopathological characteristics; (2) To compare clinical, endoscopic, and histopathological outcomes between patients undergoing clinical treatment and surgical treatment (fundoplication); (3) To identify factors independently associated with total or partial BE regression. Methods This prospective comparative study included 225 patients from HCFMUSP, with 47 receiving clinical treatment and 178 undergoing fundoplication, with a mean follow-up of 127.2 months. Patients with esophageal columnar epithelium greater than 1.0 cm were included, excluding those with less than 12 months of follow-up or initial dysplasia/adenocarcinoma. Data collection encompassed demographic information, anthropometrics, habits, and initial and final endoscopic and histopathological characteristics, employing appropriate statistical analyses for continuous and categorical variables, as well as binary logistic regression. The evolution of BE extent, presence of intestinal metaplasia (IM), occurrence of dysplasia and adenocarcinoma, and control of symptoms and comorbidities were evaluated. exploring the influence of clinical variables and treatment type. Results The overall cohort showed male predominance (60.9%), mean age 52.3 years, mean BMI of 26.3 Kg/cm2, white ethnicity (89.8%), and non-smokers (59.1%). The initial mean BE extent was 3.4 cm (47.6% with long BE) and hiatal hernia in 74.7% of cases. Surgical treatment demonstrated superiority in long-term outcomes: complete BE regression (31.5% vs. 12.8%, p=0.011), reduction in mean extent (2.5 cm vs. 3.4 cm, p<0.001), IM regression (38.8% vs. 12.8%, p=0.001) in operated patients. The incidence of low-grade dysplasia was lower in the surgical group (0.6% vs. 8.5%, p=0.009). Reflux symptoms associated were less frequent in the surgical group (9.6% vs 29.8%, p<0.001), as were unfavorable clinical outcomes (14.6% vs. 29.8%, p=0.015). 40.4% of surgical patients discontinued Proton Pump Inhibitors (PPIs). Multivariate analysis identified surgical treatment (OR = 4.87; p < 0.001) and female gender (OR = 1.88; p = 0.041) as factors independently associated with BE regression. Conclusion Laparoscopic fundoplication offers superior oncological and clinical benefits compared to PPIs in selected patients, promoting greater metaplasia regression, lower risk of progression to low-grade dysplasia, reduced medication usage, and better clinical outcomes. Surgery was independently associated with BE regression.