Correction of cardioesophageal transition as a stage of treatment after endoscopic welding of esophageal metaplasia

Annotation. Barrett’s esophagus is an acquired condition that develops as a result of the replacement of normal stratified squamous epithelium in the lower part of the esophagus by columnar epithelium. Barrett’s esophagus is considered a complication of gastroesophageal reflux disease (GERD). It has been shown and proven that various endoscopic methods are successful in treating this condition. However, long-term success in preventing further metaplasia and dysplasia is incompletely studied. Biological welding – controlled action of high frequency current on living tissues. It is used to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa. The aim of this study was to evaluate the success of endoscopic treatments for Barrett's esophagus and the need for further surgery in patients with GERD complicated by Barrett’s esophagus. Patients with Barrett’s esophagus C1-3M2-4 (Prague classification 2004) and severe dysplasia without nodule, as well as confirmed GERD without esophageal hernia were included. A total of 98 patients were included in the study, of whom 89 were re-consulted and examined after primary Barrett's esophageal ablation. Endoscopic treatment was performed by argon-plasma coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients were re-examined. Patients with recurrent metaplasia and a high DeMeester index (˃100) underwent antireflux surgery – crurography (if necessary) and Nissen fundoplication with a soft and short cuff. Recurrence of small bowel metaplasia was recorded in 15 patients. 12 patients underwent a two-stage treatment: first a second session of esophageal ablation, and in the second stage - antireflux surgery. 2 patients refused surgical treatment and underwent only the second session of ablation. All patients received drug therapy – prokinetics and proton pump inhibitors. Three months after surgery, pH metry was performed again, which showed normalization of the DeMeester index, as a result of which patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. Esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus according to the Seattle protocol was also performed. After examination of the histological material of metaplasia zones were not recorded. It is concluded that antireflux surgery is required as part of Barrett’s esophageal treatment to prevent further dysplasia and the development of esophageal cancer.

Download Full-text

Anti reflux surgery is needed after endoscopic treatment for Barrett’s esophagus

Polish Journal of Surgery ◽

10.5604/01.3001.0014.8863 ◽

2021 ◽

Vol 93 (5) ◽

pp. 1-5

Author(s):

Volodymyr Tyselskyi ◽

Andrey Kebkalo ◽

Vitaliy Poylin ◽

Olga Tkachuk

Keyword(s):

Barrett’S Esophagus ◽

High Frequency ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Antireflux Surgery ◽

Esophageal Mucosa ◽

Endoscopic Techniques ◽

Stratified Squamous Epithelium ◽

Living Tissues

Introduction: Barrett's esophagus – is an acquired condition that develops as a result of replacement of normal stratified squamous epithelium in the lower part of the esophagus with columnar epithelium. Barrett's esophagus is considered to be complication by gastroesophageal reflux disease (GERD). Various endoscopic techniques have been shown to be successful in treatment of this condition. However, long term success in preventing further dysplasia is not clear. Biological welding - controlled action of high frequency current on living tissues has been used in to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa Objective: The goal of this study is to evaluate success of endoscopic techniques in treatment of Barrett’s esophagus and need for subsequent surgical intervention in patients with GERDcomplicated by Barrett's esophagus. Materials and methods: Patients with Barrett's esophagus C1-3M2-4 (Prague classification in 2004) and high dysplasia without nodules, as well as confirmed GERD without hiatal hernia were included. Endoscopic treatment was performed by argonoplasmic coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients re-examined. Patients with recurrence of metaplasia and high De Meester index (˃ 100) underwent antireflux surgery - crurography and Nissen fundoplication with a soft and short cuff. Results: A total of 89 patients were included in the study, of which 81 were reexamined after ablation of Barrett's esophagus. In 12 patients, a relapse of small bowel type metaplasia was recorded. Nine patients underwent two-stage treatment - first, a second session of ablation of the esophagus, and at the second stage, antireflux surgery. 3 patients refused surgical treatment and underwent only a second ablation session. All patients received drug therapy - prokinetics and proton pump inhibitors. 3 months after the operation, the pH metry was repeated, which showed the normalization of the De Meester index, and as a result, the patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus in accordance with the Seattle Protocol. After examining the histological material, no metaplasia zones were recorded. Conclusions: Antireflux surgery is required as part of the treatment of Barrett’s esophagus to prevent further dysplasia and development of esophageal cancer.

Download Full-text