This multinational and population-based cohort study included all patients with a diagnosis of Barrett\'s esophagus in any of the national patient registries in Denmark (2012-2020), Finland (1987-1996 and 2010-2020), Norway (2008-2020), or Sweden (2006-2020). Patients who underwent antireflux surgery were compared with nonoperated patients using antireflux medication. The risk of esophageal adenocarcinoma was calculated using multivariable Cox regression, providing hazard ratios (HRs) and 95% CIs adjusted for age, sex, country, calendar year, and comorbidity.
The cohort consisted of 33,939 patients with Barrett\'s esophagus. Of these, 542 (1.6%) had undergone antireflux surgery. During up to 32 years of follow-up, the overall HR was not decreased in patients having undergone antireflux surgery compared with nonoperated patients using antireflux medication, but rather increased (adjusted HR, 1.9; 95% CI, 1.1-3.5). In addition, HRs did not decrease with longer follow-up, but instead increased for each follow-up category, from 1.8 (95% CI, 0.6-5.0) within 1-4 years of follow-up to 4.4 (95% CI, 1.4-13.5) after 10-32 years of follow-up.
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.
方法:这项跨国和基于人群的队列研究纳入了丹麦任何国家患者登记(2012-2020)中所有诊断为Barrett食管的患者,芬兰(1987-1996年和2010-2020年),挪威(2008-2020年),或瑞典(2006-2020年)。将接受抗反流手术的患者与使用抗反流药物的非手术患者进行比较。使用多变量Cox回归计算食管腺癌的风险,提供根据年龄调整的95%置信区间(CI)的风险比(HR),性别,国家,日历年,和合并症。
结果:该队列包括33,939例Barrett食管患者。其中,542(1.6%)接受了抗反流手术。在长达32年的随访中,与使用抗反流药物的非手术患者相比,接受抗反流手术的患者的总HR没有降低,而是升高(校正HR1.9,95%CI1.1~3.5).此外,HR没有随着随访时间的延长而降低,但每个后续类别都增加了,从随访1-4年内的1.8(95%CI0.6-5.0)到随访10-32年后的4.4(95%CI1.4-13.5)。
结论:接受抗反流手术的Barrett食管患者似乎没有比使用抗反流药物的患者更低的食管腺癌风险。