Prevention of Barrett's Metaplasia in a Human Model of Duodenogastro-Oesophageal Reflux

The development of Barrett’s esophagus above the anastomosis following esophagogastrectomy has been reported in several studies. In this prospective study we set out to examine the prevalence of this phenomenon in a group of patients who have been strictly adherent to post operative proton pump inhibitor (PPI) therapy. Forty-six postoesophagectomy patients were prospectively assessed by upper gastrointestinal endoscopy. Four quadrant biopsies were taken 1 cm proximal to the esophago-gastric anastomosis in all patients and details of endoscopic appearance, biopsy pathology, operative pathology and PPI dose were recorded. All 46 patients had been commenced on a PPI in the immediate postoperative period. Two patients were not taking a PPI regularly. The average time from operation to endoscopy was 3 years (range 0.5 to 9). Mild (Grade 1) erosive oesophagitis was observed in 5 patients. Barrett’s epithelium was not identified in any patient. One patient who was taking a PPI intermittently had macroscopic columnar epithelium for 2 cm above the anastomosis without intestinal metaplasia. One other patient who had no macroscopic abnormality had columnar epithelium without intestinal metaplasia, seen in one of four biopsy specimens. This is the first study to assess for endoscopic evidence of neo-Barrett’s following oesophagogastrectomy, where PPI therapy has been commenced in the immediate postoperative period. Columnar epithelium was present in 2 patients and intestinal metaplasia was not detected in any of the cohort. These outcomes may be due to early commencement of PPI therapy and a high level of compliance.