Surgery & Cancer Risk
This is updated from a page originally provided by Barrett's Wessex charity.
In USA, the CALIBER trial (sponsored by Linx manufacturer Torax) has been comparing LINX to PPI therapy for elimination of reflux.
In UK, researchers are looking for funding to conduct a similar trial. Details of the proposed LINACRE trial may be found here, LINACRE TRIAL, with the hope it may be effective in reducing the risk of Barrett's becoming cancer.
WHAT IS KNOWN SO FAR:
STOPPING REFLUX with LINX
MagneticSphincter Augmentation Superior to Proton Pump Inhibitors forRegurgitation in a 1-Year Randomized Trial (Clinical Gastroenterology & Hepatology 2020)
MagneticImplant Controls Regurgitation ‘Far Better’ Than PPIs in GERD (Gastroenteroloy & Endoscopy)
Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial (Clinical Endoscopy 2019)
Linx more effective than PPIs for treating regurgitation in GERD (Healio 2017)
PREVENTING BARRETT'S MUTATING TO CANCER SURGICALLY
REFLUX & EAC
Long-termEfficacy of Laparoscopic Antireflux Surgery on Regression ofBarrett's Esophagus Using BRAVO Wireless pH Monitoring: A ProspectiveClinical Cohort Study (Annals of Surgery 2017):
“An intact fundoplication, as assessed with BRAVO wireless pH monitoring, suggests that antireflux surgery may halt the progression of Barrett's esophagus, and this might reduce the risk of cancer development.”
Effect of Antireflux Surgery for Barrett's Esophagus: Long-Term Results (Minerva Chirurgica 2016):
“Regression of features associated with cancer risk was more common after surgery than medical therapy.”
AntirefluxSurgery and Risk of Esophageal Adenocarcinoma: A Systematic Review and Meta-analysis (Annals of Surgery 2016):
“Antireflux surgery may prevent EAC better than medical therapy in patients with Barrett's esophagus. The EAC risk after antireflux surgery does not seem to revert to that of the background population.”
EsophagealAdenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries (Annals of Surgery 2021):
“Surgical treatment of GERD does not seem to reduce EAC risk.”
Survival After Anti-Reflux surgery versus Medication in Patients With Reflux Oesophagitis or Barrett's Oesophagus (British Journal of SUrgery 2021):
"In patients with reflux oesophagitis or Barrett's oesophagus, antireflux surgery is associated with lower mortality from all causes, cardiovascular disease, respiratory disease, laryngeal or pharyngeal cancer, and lung cancer, but not from oesophageal cancer, compared with antireflux medication."
Antireflux Surgery Versus Antireflux Medication and Risk of Esophageal Adenocarcinoma in Patients With Barrett’s Esophagus (Gastroenteroloy 2023)
"Patients with Barrett’s esophagus who undergo antireflux surgery do not seem to have a lower risk of esophageal adenocarcinoma than those using antireflux medication."
Antireflux Surgery Does Not Prevent Cancer in Barrett’s Esophagus (Commentary on above)
" for now, the best we have is what is currently recommended: Practice careful surveillance endoscopy when Barrett’s is detected and ablate dysplastic Barrett’s. Unfortunately, that hasn’t proven to be very successful in reducing the occurrence of EAC, because it manages only the small fraction of EAC cases that occur through that pathway; most EAC is detected via incident endoscopy after the development of dysphagia, at which point the outcome is poor. To move the needle, we need to change the focus from preventing cancer in known Barrett’s to detecting Barrett’s in the general population, likely through use of a nonendoscopic method such as Cytosponge with cytology analysis or EsoGuard with DNA analysis. Only then will it be feasible to improve survival in EAC. "
HOW PPIS REDUCE EAC RISK?
Page updated 2 November 2023