الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
I
n patients with BE, anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. Endoscopic resection of visible lesions if any, followed by ablation of the rest of the BE epithelium is the current standard of care for management of BE with confirmed dysplasia. Although the current literature describes multiple endoscopic and anti-reflux techniques for the management of BE, there is no published evidence on the efficacy of anti-reflux surgery followed by endoscopic management on the outcomes of BE. The objective of this study was to compare between anti-reflux surgery with or without endoscopic management of BE.
In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 6 studies were included.
In the present systematic review and meta-analysis, we observed that the majority of the patients were males and aged more than 60 years old. We found that the prevalence of hiatal hernia among BE cases ranged from 60-98%.
In the present systematic review and meta-analysis, four studied used RFA alone and two studies used RFA plus EMR. Five studies reported the rates of complete eradication of intestinal metaplasia. The overall effect estimates showed the rate of complete eradication of intestinal metaplasia was 65.5% (95% CI 47– 84%). Regarding the rate of complete eradication of dysplasia in the present study, we found that five studies reported the rates of complete eradication of dysplasia. The overall effect estimates showed the rate of complete eradication of dysplasia was 69.7% (95% CI 54.4– 85%).
In the present systematic review and meta-analysis, five studies reported the rates of recurrence. The overall effect estimates showed the rate of recurrence was 5.7% (95% CI 1.2– 10.2%).
In the present systematic review and meta-analysis, five studies reported the overall complications rate. The overall effect estimates showed the overall complications rate was 7.3% (95% CI 4.1– 10.6%), mainly stricture and perforation.
In conclusion, endoscopic procedures after anti-reflux surgery is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the management of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal extent of columnar esophagus. This combination provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first-line of treatment for BE.