Esophageal surgeries in systemic sclerosis (SSc) - a systematic review of the literature

Objectives: In some patients with systemic sclerosis (SSc), esophageal symptoms can be severe enough to warrant surgical intervention; however, no single procedure seems to predominate because there exists no published rationale for the choice of a particular procedure. We did a systematic literature review of all published trials involving patients with SSc requiring esophageal surgery and compared their relative outcomes and complications. Methods: All articles (excluding review articles) describing esophageal surgeries in SSc patients published between 1965 and November 2015 were reviewed. A minimum of 12 weeks' follow-up was also needed for inclusion. Primary outcome measures were improvement of patient-and/or physician-described reduction in heartburn, reflux or dysphagia. Complications related and unrelated to the procedure were also evaluated. Results: Ten articles satisfied selection criteria. A total of 119 patients, all >= 18 years of age, were included from the 10 articles selected Excluding the 1-2 patient case reports, favorable responses were seen in 30%-81% of patients. Complications were varied and differed from series to series Conclusions: The efficacy of the procedure and the specific surgical approach to use remains based on anecdotal data. There is clearly a need for careful, controlled studies in uniform groups of SSc patients before being able to rationally recommend esophageal surgery for dysphagia/heartburn in SSc.