Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus in patients with fundoplications.
BACKGROUND
Endoscopic endoluminal radiofrequency ablation using the Barrx device is a new technique to treat Barrett's esophagus. This procedure has been used in patients who have not had antireflux surgery. This report is presents an early experience of the effects of endoluminal ablation on the reflux symptoms and completeness of ablation in post-fundoplication patients.


METHODS
Seven patients who have had either a laparoscopic or open Nissen fundoplication and Barrett's esophagus underwent endoscopic endoluminal ablation of the Barrett's metaplasia using the Barrx device (Barrx Medical, Sunnyvale, CA). Preprocedure, none of the patients had significant symptoms related to gastroesophageal reflux disease. One to two weeks after the ablation, patients were questioned as to the presence of symptoms. Preprocedure and postprocedure, they completed the GERD-HRQL symptom severity questionnaire (best possible score, 0; worst possible score, 50). Patients had follow-up endoscopy to assess completeness of ablation 3 months after the original treatment.


RESULTS
All patients completed the ablation without complications. No patients reported recurrence of their GERD symptoms. The median preprocedure total GERD-HRQL score was 2, compared to a median postprocedure score of 1. One patient had residual Barrett's metaplasia at 3 months follow-up, requiring re-ablation.


CONCLUSIONS
This preliminary report of a small number of patients demonstrates that endoscopic endoluminal ablation of Barrett's metaplasia using the Barrx device is safe and effective in patients who have already undergone antireflux surgery. There appears to be no disruption in the fundoplication or recurrence of GERD-related symptoms. Nevertheless, longer-term follow-up with more patients is needed.
Hubbard
N
N
Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, Michigan 48202-2689, USA.
Velanovich
V
V
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001707:Biopsy, Needle; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome