Impact of surgical vs medical management on histologic outcomes in Barrett’s esophagus: A meta-analysis

doi:10.3748/wjg.119387

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Meta-Analysis

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Sep 21, 2026; 32(35): 119387
Published online Sep 21, 2026. doi: 10.3748/wjg.119387

Impact of surgical vs medical management on histologic outcomes in Barrett’s esophagus: A meta-analysis

Richard R Gurski, Lorenzo O Dias, Luciano P Marcelino, Vinicius J Campos, Dirceu F Valentini Jr, Bruna B M Isbert

Bruna B M Isbert, Dirceu F Valentini Jr, Lorenzo O Dias, Richard R Gurski, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Rio Grande do Sul, Brazil

Vinicius J Campos, Luciano P Marcelino, Richard R Gurski, Service of Digestive Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Rio Grande do Sul, Brazil

Co-corresponding authors: Bruna B M Isbert and Richard R Gurski.

Author contributions: Isbert BBM contributed to the study conception and design, data acquisition, data analysis, drafting of the manuscript, and interpretation of the results; Valentini Jr DF contributed to data acquisition, drafting of the manuscript, and interpretation of the results; Campos VJ contributed to data acquisition and critical revision of the manuscript; Marcelino LP contributed to data acquisition and critical revision of the manuscript; Dias LO contributed to data acquisition and critical revision of the manuscript; Gurski RR contributed to study supervision, interpretation of the results, and critical revision of the manuscript. All the authors approved the final version of the manuscript; Gurski RR will serve as the primary contact for correspondence with the journal. Isbert BBM and Gurski RR contributed equally as co-corresponding authors. Two co-corresponding authors were designated because the scientific and administrative responsibilities of this manuscript were shared throughout the submission and publication process. Gurski RR served as corresponding author due to his active institutional affiliation and senior academic role, which facilitated the formal submission procedures and institutional representation of the study. Isbert BBM had the primary operational role in the project, including manuscript drafting, coordination of revisions, submission management, responses to editorial requests, and communication during all stages of the process. Both authors are fully familiar with the study design, data, results, and conclusions, and both are able to respond promptly to editorial, scientific, or post-publication inquiries.

AI contribution statement: ChatGPT was used occasionally and in a limited manner. The entire manuscript was written by the authors, based on and properly referenced according to the cited literature. No part of the scientific content was generated by AI. ChatGPT was used exclusively for minor language editing, grammatical refinement, improving clarity and readability, and assisting with text organization and formatting. The primary language refinement and linguistic adjustments of the manuscript were conducted by language company. No AI tool was used to generate scientific content, ideas, data, or interpretations. AI tools did not contribute to the study design, data analysis, or interpretation of results. No images were generated using AI tools. All images included in the manuscript are original. The scientific content of this manuscript is original and was produced exclusively by the authors. The manuscript was reviewed multiple times by the authors, who are fully responsible for its accuracy and integrity. Any AI-assisted input was limited, carefully checked and verified, and used only to support clarity, without influencing the scientific content.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Richard R Gurski, MD, PhD, Associate Professor, Chief Physician, Service of Digestive Surgery, Hospital de Clínicas de Porto Alegre (HCPA), No. 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, Rio Grande do Sul, Brazil. rgurski@hcpa.edu.br

Received: January 26, 2026
Revised: February 22, 2026
Accepted: May 15, 2026
Published online: September 21, 2026
Processing time: 205 Days and 5.1 Hours

Abstract

BACKGROUND

Barrett’s esophagus (BE) is a premalignant condition associated with esophageal adenocarcinoma, yet its optimal management remains controversial. Proton pump inhibitors (PPIs) are widely used, whereas antireflux surgery may provide more effective reflux control and potentially influence histologic outcomes. However, comparative evidence regarding BE regression and progression remains inconsistent. We hypothesized that surgical fundoplication yields superior histologic outcomes compared with medical therapy.

AIM

To compare histologic regression and progression of BE following PPI therapy vs surgical fundoplication.

METHODS

We systematically searched PubMed, EMBASE, LILACS, Scopus, Web of Science, and the Cochrane Library through December 2023. Cohort studies comparing PPI monotherapy with fundoplication in histologically confirmed BE with ≥ 1-year endoscopic follow-up were included. A random-effects meta-analysis was performed. This review was registered in PROSPERO (CRD420251006124).

RESULTS

Of 4472 records identified, six cohort studies involving 1433 patients (912 medical, 521 surgical) were included, with a weighted mean follow-up of 66.1 months. Nissen fundoplication accounted for 94.9% of procedures. Surgery was associated with significantly higher BE regression than PPI therapy [odds ratio (OR), 0.24; 95% confidence interval (CI): 0.16-0.34]. Medical therapy was associated with a higher risk of progression to high-grade dysplasia or adenocarcinoma (OR = 2.58; 95%CI: 1.20-5.52). Overall progression showed a nonsignificant trend favoring surgery (OR = 3.28; 95%CI: 0.98-10.97).

CONCLUSION

Limited observational evidence suggests that fundoplication may improve histologic regression and reduce progression risk in BE; however, these findings should be interpreted cautiously.

Keywords: Gastroesophageal reflux disease; Esophagus; Barrett’s esophagus; Adenocarcinoma; Fundoplication; Antireflux surgery; Nissen; Proton pump inhibitor

Core Tip: Barrett’s esophagus is a premalignant condition for which the optimal strategy to prevent disease progression remains uncertain. This systematic review and meta-analysis directly compared surgical fundoplication with proton pump inhibitor therapy. Fundoplication was associated with higher rates of histologic regression and a reduced risk of progression to high-grade dysplasia or esophageal adenocarcinoma. By focusing exclusively on these two treatment strategies, this study provides clinically meaningful comparative evidence to inform therapeutic decision-making and long-term management in this high-risk population.