UEG Week 2023 Congress Review - 7

Congress Review
Top Abstract Prize: Surgery may
not be the answer to reducing risk
of oesophageal adenocarcinoma in
patients with Barrett's oesophagus1
A multinational and population-based cohort
study reveals that anti-reflux surgery is not superior
to anti-reflux medication in the prevention of
oesophageal adenocarcinoma among patients
with Barrett's oesophagus (BO).1
Since anti-reflux surgery has been found to be at least as
effective as anti-reflux medication in controlling some of
the key risk factors of oesophageal adenocarcinoma, it has
been hypothesised as a potential preventative for tumour
progression.2
To explore this, a comprehensive study
was conducted, comparing anti-reflux medication with
anti-reflux surgery in patients with BO, who are high risk
for oesophageal adenocarcinoma.1,3
Patients (N=33,939) recorded in national patient registries
as diagnosed with BO were included from Denmark (2012-
2020), Finland (1987-1996 and 2010-2020), Norway (2008-
2020) and Sweden (2006-2020).1
References:
1 Hardvik Åkerström J, et al. Antireflux surgery versus antireflux medication and risk of esophageal adenocarcinoma in patients with Barrett's esophagus. Presented at UEG Week 2023 Congress; 16 October 2023; Copenhagen,
Demark.
2 Holmberg D and Lagergren J. Epidemiology of Barrett's esophagus and esophageal adenocarcinoma. Foregut. 2023; 3(1):52-59. doi: https://doi.org/10.1177/26345161221138045.
3 Hussein M, et al. The natural history of low-grade dysplasia in Barrett's esophagus and risk factors for progression. JGH Open. 2021;5(9):1019-1025. doi: https://doi.org/10.1002/jgh3.12625.
Patients who underwent anti-reflux surgery (n=542) were
compared with non-operated patients using anti-reflux
medication, with a follow-up period of 32 years. During
this extended period, multivariate Cox regression showed
that patients who underwent anti-reflux surgery did not
experience a reduction in the overall hazard ratio (HR)
compared with those who used anti-reflux medication
without surgery; instead, the HR increased (adjusted HR: 1.9;
95% CI [confidence interval]: 1.1-3.5). Furthermore, as the
follow-up duration extended, HRs did not exhibit a decline,
but an upward trend, rising from 1.8 (95% CI: 0.6-5.0) within
1 to 4 years of follow-up to 4.4 (95% CI: 1.4-13.5) after 10 to 32
years of follow-up.1
The findings from this study indicate that among patients
with BO, there is no observed reduction in the risk of
oesophageal adenocarcinoma following anti-reflux surgery
when compared with anti-reflux medication. In fact, the risk
was observed to increase over the course of the follow-up
period among those who had undergone anti-reflux surgery.1
This Top Abstract Prize was awarded to Johan Hardvik
Akerström and presented in Copenhagen by Dag Holmberg.
Watch the presentation
7

https://ueg.eu/missed-antireflux-surgery https://www.doi.org/10.1177/26345161221138045 https://www.doi.org/10.1002/jgh3.12625

UEG Week 2023 Congress Review

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