title: Ultrasonic epithelial ablation of the lower esophagus without stricture formation. A new technique for Barrett's ablation.
abstract: BACKGROUND
  The premalignant potential of Barrett's esophagus has stimulated efforts to find a way to ablate the columnar epithelium in order to reheal the area with squamous epithelium, thus obviating the cancer risk. This study describes and evaluates a new technique using ultrasonic energy to ablate the epithelium of the lower esophagus in a porcine model.
  
  
  METHODS
  Eight young farm pigs were used to develop the technique of applying a laparoscopic Cavitron Ultrasonic Surgical Aspirator (CUSA) to the lower esophageal mucosa through an operating gastrostomy. A further 11 Yakutan minipigs then underwent CUSA epithelial ablation, followed by a laparoscopic Nissen fundoplication or postoperative acid suppression therapy. We then assessed the healing response in these subjects.
  
  
  RESULTS
  Optimal CUSA energy settings enabled complete ablation of the squamous epithelium with preservation of the muscularis mucosa and submucosa. The integrity of the aspirated cells was sufficient for cytological analysis. Healing occurred by squamous regeneration without stricture formation.
  
  
  CONCLUSIONS
  The CUSA technique holds promise for complete ablation of the Barrett's epithelium in a single setting. The unique tissue-selective nature of the ablative process allows complete mucosal reepithelialization without stricture formation.
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA 90033-4612, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Bremner
authors.forename: R J
authors.initials: RJ
authors.lastname: Mason
authors.forename: C G
authors.initials: CG
authors.lastname: Bremner
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: P
authors.initials: P
authors.lastname: Chandrasoma
authors.forename: J H
authors.initials: JH
authors.lastname: Peters
authors.forename: J A
authors.initials: JA
authors.lastname: Hagen
authors.forename: M
authors.initials: M
authors.lastname: Gadenstätter
mesh_terms: D000818:Animals; D001471:Barrett Esophagus / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D013552:Swine; D014464:Ultrasonic Therapy / Q000379:methods*