Two Arguments in Favor of Surgery

A particularly positive feature of the article by Gockel and colleagues was the fact that the therapeutic options were presented in a balanced way; endoscopic treatment received fair attention, although the lead author is a surgeon. In particular, the authors refrained from going into great detail about the technical problems of balloon dilatation in the cited study (1) and the ensuing deserved criticisms relating to the entire study arm, since these are certainly not representative for the balloon dilatation approach.

However, as a gastroenterologist and specialist in internal medicine I am surprised that two arguments in favor of surgery, especially in younger patients, were not made clear. Firstly, published follow-up data for endoscopic treatment are mostly available for two years only (up to a maximum of five years), whereas long-term successes of five and 10 years have been documented for surgical treatment. Secondly, the surgical approach in addition to simultaneous (semi-)fundoplication, which is carried out as standard treatment nowadays, provides a solution to the reflux problem that is associated with any treatment.

Even though—as in the recent 2012 annual meeting of the German Society for Endoscopy and Imaging Procedures—endoscopy is often credited as the primary therapeutic approach, surgery is an important alternative in patients refractory to treatment and in younger patients, whose advantages are its high success rates and the long-term therapeutic success.

DOI: 10.3238/arztebl.2012.0534a

Prof. Dr. med. Thomas Rabenstein

Diakonissen-Stiftungs-Krankenhaus Speyer

thomas.rabenstein@diakonissen.de

Conflict of interest statement
The author has received lecture honoraria and funding for commissioned clinical studies from Dr Falk and Norgine.