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The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 826-835, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AP Naef, M Savary and L Ozzello
The analysis of a series of 1,225 cases of reflux esophagitis shows the
serious nature of this condition. A liberal use of antireflux operations
therefore seems justified. Extensive columnar metaplasia of the distal
esophagus, or columnar-lined lower esophagus (CLLE), represents a late
irreversible stage of reflux esophagitis. Repeated esophagoscopies
demonstrate the acquired nature of the lesion. It is caused by the
progressive healing, from below upward, of peptic ulcerations on the
squamous epithelium by metaplasia of columnar mucosa. Antireflux operations
stop the progressive ascent of heterotopic epithelium and thus stabilize
reflux esophagitis and cure complications such as ulcerations and
strictures. The premalignant character of this condition is established by
a 10 per cent incidence of adenocarcinomas in a series of 140 cases of
extensive columnar metaplasia. The transition toward malignancy seems to be
irreversible and cannot be arrested by an antireflux operation. Therefore,
repeated esophagoscopic controls and biopsies are an absolute necessity in
all cases of extensive columnar metaplasia, even after cure of active
reflux esophagitis by Nissen fundoplication.
ARTICLES
Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas
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