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首页> 外文期刊>Surgical Endoscopy >Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus: initial results and lessons learned.
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Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus: initial results and lessons learned.

机译：Barrett食管的内镜腔内射频消融：初步结果和经验教训。

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BACKGROUND: Ablating Barrett's epithelium may reduce the risk of developing esophageal adenocarcinoma. This study reports the experience of a single surgeon using an endoscopic endoluminal device that delivers radiofrequency energy (the BARRx device) to ablate Barrett's esophagus. METHODS: All patients who underwent ablation of Barrett's epithelium with the BARRx system were reviewed for length of Barrett's metaplasia, presence of high-grade dysplasia, postprocedure complications, completeness of ablation at first follow-up endoscopy, need for additional ablation, completeness of ablation at second follow-up endoscopy, and concomitant performance of a Nissen fundoplication. RESULTS: Sixty-six patients underwent Barrett's ablation. The median length of the Barrett's esophagus was 3 (range, 1-14) cm. Twelve patients (18%) had high-grade dysplasia. There were no immediate procedure-related complications. Four strictures occurred: three in patients with > or = 12-cm segments of Barrett's and one in a 6-cm segment. Twenty-nine of 49 patients (59%) who had planned 3-month follow-up endoscopy had complete ablation. Five patients had planned two-stage ablation. Twenty patients with incomplete ablation had additional ablation. Twenty-seven patients had planned follow-up endoscopy at > or = 1 year: 25 of 27 (93%) had biopsy-proven normal esophageal mucosa. The median length of Barrett's esophagus in patients with initially incomplete ablation was 6 cm, compared with 2 cm in the initially complete ablation patients. Seven Nissen fundoplications were present at the time of ablation, whereas six were performed concomitantly with the ablation without increased difficulty. CONCLUSIONS: Complete ablation of Barrett's esophagus with radiofrequency endoluminal ablation is achievable in > 90% of patients. Patients with longer segments are likely to require additional ablation. Patients with very long segments are at risk for stricture and should be approach cautiously. Performance of a fundoplication is not hindered by concomitant ablation.
机译：背景：消融巴雷特上皮可能会降低患食管腺癌的风险。这项研究报告了一个单一的外科医生使用内窥镜腔内装置递送射频能量（BARRx装置）以消融Barrett食道的经验。方法：对所有使用BARRx系统进行Barrett上皮消融的患者进行了Barrett上皮化生的长度，高度不典型增生，术后并发症，首次随访内镜下消融的完整性，是否需要额外消融，消融的完整性的检查在第二次随访内窥镜检查中，以及伴随尼森胃底折叠术的表现。结果：66例患者接受了巴雷特的消融术。巴雷特食管的中位长度为3（范围1-14）cm。十二名患者（占18％）患有高度不典型增生。没有与手术相关的即时并发症。发生四处狭窄：巴雷特氏段≥12 cm的患者中有三处狭窄，而在6 cm区段中有1条。计划进行3个月的随访内窥镜检查的49例患者中有29例（59％）完全消融。五例患者计划进行两阶段消融。 20例不完全消融的患者进行了额外的消融。 27例计划≥1年的随访内窥镜检查：27例中的25例（93％）具有经活检证实的正常食管粘膜。最初不完全消融的患者的Barrett食道中位长度为6 cm，而最初完全消融的患者为2 cm。消融时出现7例Nissen胃底折叠术，而消融术同时进行了6例，且难度没有增加。结论：> 90％的患者可实现Barrett食管完全消融和射频腔内消融。更长节段的患者可能需要额外消融。具有很长段的患者存在狭窄风险，应谨慎对待。胃底切除术的进行不受消融的影响。

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