title: Concomitant endoscopic radiofrequency ablation and laparoscopic reflux operative results in more effective and efficient treatment of Barrett esophagus.
abstract: BACKGROUND
  Barrett esophagus (BE) caused by gastroesophageal reflux disease can lead to esophageal cancer. The success of endoscopic treatments with BE eradication depends on esophageal anatomy and post-treatment acid exposure.
  
  
  METHODS
  Between January 2008 and December 2009, 10 patients were selected for combination treatment of BE using laparoscopic anti-reflux surgery and endoscopic radiofrequency ablation. Retrospective review of preoperative, procedural, and postoperative data was performed.
  
  
  RESULTS
  Seven study patients had a pathologic diagnosis of nondysplastic BE and 3 patients had a diagnosis of low-grade dysplasia. Average length of BE lesions was 6.4 ± 4.8 cm. Procedure time averaged 154.4 ± 46.4 minutes. At the time of surgery, the mean number of ablations performed was 4.39 ± 1.99. Six patients were noted to have major hiatal hernias requiring reduction. Five patients (80%) had 100% resolution of their BE at their first postoperative endoscopy. The remaining 3 patients had a ≥50% resolution and underwent subsequent endoscopic ablation. Symptomatic results revealed that 4 patients had substantial dysphagia to solids and other symptoms were minimal. Two patients were noted to have complications related to the ablative treatments. One stricture and 1 perforation were observed.
  
  
  CONCLUSIONS
  Endoscopic radiofrequency ablation of BE at the time of laparoscopic fundoplication is feasible and can effectively treat BE lesions. A single combined treatment can result in fewer overall procedures performed to obtain BE eradication.
authors.affiliation: GI/Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR 97210, USA.
authors.forename: Trudie A
authors.initials: TA
authors.lastname: Goers
authors.forename: Pedro
authors.initials: P
authors.lastname: Leão
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
mesh_terms: D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome