From Our Archives

GERD Surgery Doesn't Prevent Cancer

One type of cancer of the esophagus, adenocarcinoma, is increasing more rapidly than any other cancer in both Western Europe and the US. Gastroesophageal reflux disease (GERD) appears to be an important risk factor (and possible cause) of this adenocarcinoma. It is believed that in GERD, injury to the cells lining the esophagus by refluxed acid causes the cells to change. The changes (referred to as Barrett's esophagus) make the cells more likely to become adenocarcinomas.

The approach to treatment of uncomplicated GERD (simple heartburn) is to control symptoms by controlling acid (medication) or reflux (surgery). Complications of GERD, such as Barrett's esophagus or scarring and narrowing of the esophagus, are treated with either aggressive control of the acid--irrespective of symptoms--or anti-reflux surgery (also known as fundoplication). It is recommended that patients who develop Barrett's esophagus should undergo regular screening with gastrointestinal endoscopy and biopsy so that adenocarcinoma can be discovered early and cured.

For many years, the standard surgical method for treating GERD involved a large incision in the upper abdomen. More recently, laparoscopic surgical techniques have been developed. Laparoscopic surgery requires only several small puncture wounds in the abdomen rather than a large incision. Laparoscopic surgery appears to be as effective as surgery utilizing large incisions, but results in less discomfort and a faster recovery. The relative comfort of laparoscopic surgery has prompted more patients with GERD to chose surgery over medication. The most recent techniques for treating GERD are endoscopic. (Endoscopy utilizes long tubes fitted with fiber-optics that can be swallowed. The fiber-optics allow the inside of the esophagus and stomach to be visualized without cutting them open. Small instruments also can be passed through channels in the tube to perform minor surgical procedures.) Endoscopic techniques are expected to be even more comfortable and have a faster recovery than laparoscopic surgery, but it is too early to know how effective endoscopic techniques will be.