Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up.
BACKGROUND
The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.


METHODS
Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.


RESULTS
Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.


CONCLUSIONS
Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.
Frantzides
Constantine T
CT
Chicago Institute of Minimally Invasive Surgery, Skokie, IL 60077, USA. cfrantzides@cimis.info
Carlson
Mark A
MA
Keshavarzian
Ali
A
Roberts
Jacob E
JE
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D013270:Stomach / Q000601:surgery; D016896:Treatment Outcome