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Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett's esophagus.
Surg Endosc 2011; 25(3):830-4SE

Abstract

BACKGROUND

Endoscopic endoluminal radiofrequency ablation is achieving increasing acceptance as a mode of eliminating Barrett's metaplasia and, thus, reducing the risk of developing esophageal adenocarcinoma. It is believed that reducing exposure of the esophageal epithelium to acid is essential to achieve long-term ablation of Barrett's esophagus. However, it is unclear whether use of proton pump inhibitors or antireflux operations are more effective to accomplish this goal.

METHODS

All patients who underwent endoscopic endoluminal radiofrequency ablation with the BARRx device (BARRx Medical, Sunnyvale, CA) were reviewed for date of initial ablation, length of Barrett's epithelium, presence or performance of Nissen fundoplication, all follow-up endoscopy and treatment, and posttreatment biopsy results. Patients were categorized by presence of Nissen fundoplication and presence of Barrett's metaplasia or dysplasia by biopsy at least 12 months following ablation and at last endoscopic follow-up. Data were analyzed by Fisher's exact test and Mann-Whitney U-test.

RESULTS

Of 77 patients ablated, 47 had documented endoscopic follow-up at 12 months or longer following the ablation. Of these, 19 patients had Nissen fundoplication before, at the same time, or after ablation. Median length of Barrett's epithelium, with interquartile range (IQR), was 3 (2-12) cm in patients with fundoplication compared with 3 (2-7) cm without fundoplication (P = NS). Median follow-up was 15 (12-24) months in fundoplication patients compared with 12.5 (12-17) months without (P = NS). One of 19 patients with fundoplication had persistent or recurrent Barrett's epithelium, compared with 7 of 28 without fundoplication (P = 0.03). Of patients without fundoplication, those who had persistent or recurrent Barrett's had median Barrett's length of 10 cm (6-12 cm) compared with 3 cm (2-5 cm) in patients who had ablated Barrett's (P = 0.03). Follow-up length was similar in those with ablated epithelium, 15 months (12-19 months), compared with those with persistent or recurrent Barrett's, 12 months (12-13 months) (P = NS).

CONCLUSIONS

Patients who had fundoplication in conjunction with endoluminal radiofrequency ablation were more likely to achieve durable ablation compared with patients who were treated with proton pump inhibitor therapy. It appears that patients with long-segment Barrett's esophagus are at higher risk for persistent or recurrent Barrett's metaplasia. Consideration should be given for an antireflux operation in patients with long-segment Barrett's esophagus and planned endoluminal radiofrequency ablation.

Authors+Show Affiliations

Division of General Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.No affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

20676687

Citation

O'Connell, Kathleen, and Vic Velanovich. "Effects of Nissen Fundoplication On Endoscopic Endoluminal Radiofrequency Ablation of Barrett's Esophagus." Surgical Endoscopy, vol. 25, no. 3, 2011, pp. 830-4.
O'Connell K, Velanovich V. Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett's esophagus. Surg Endosc. 2011;25(3):830-4.
O'Connell, K., & Velanovich, V. (2011). Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett's esophagus. Surgical Endoscopy, 25(3), pp. 830-4. doi:10.1007/s00464-010-1270-0.
O'Connell K, Velanovich V. Effects of Nissen Fundoplication On Endoscopic Endoluminal Radiofrequency Ablation of Barrett's Esophagus. Surg Endosc. 2011;25(3):830-4. PubMed PMID: 20676687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett's esophagus. AU - O'Connell,Kathleen, AU - Velanovich,Vic, Y1 - 2010/07/30/ PY - 2010/04/15/received PY - 2010/07/02/accepted PY - 2010/8/3/entrez PY - 2010/8/3/pubmed PY - 2011/7/2/medline SP - 830 EP - 4 JF - Surgical endoscopy JO - Surg Endosc VL - 25 IS - 3 N2 - BACKGROUND: Endoscopic endoluminal radiofrequency ablation is achieving increasing acceptance as a mode of eliminating Barrett's metaplasia and, thus, reducing the risk of developing esophageal adenocarcinoma. It is believed that reducing exposure of the esophageal epithelium to acid is essential to achieve long-term ablation of Barrett's esophagus. However, it is unclear whether use of proton pump inhibitors or antireflux operations are more effective to accomplish this goal. METHODS: All patients who underwent endoscopic endoluminal radiofrequency ablation with the BARRx device (BARRx Medical, Sunnyvale, CA) were reviewed for date of initial ablation, length of Barrett's epithelium, presence or performance of Nissen fundoplication, all follow-up endoscopy and treatment, and posttreatment biopsy results. Patients were categorized by presence of Nissen fundoplication and presence of Barrett's metaplasia or dysplasia by biopsy at least 12 months following ablation and at last endoscopic follow-up. Data were analyzed by Fisher's exact test and Mann-Whitney U-test. RESULTS: Of 77 patients ablated, 47 had documented endoscopic follow-up at 12 months or longer following the ablation. Of these, 19 patients had Nissen fundoplication before, at the same time, or after ablation. Median length of Barrett's epithelium, with interquartile range (IQR), was 3 (2-12) cm in patients with fundoplication compared with 3 (2-7) cm without fundoplication (P = NS). Median follow-up was 15 (12-24) months in fundoplication patients compared with 12.5 (12-17) months without (P = NS). One of 19 patients with fundoplication had persistent or recurrent Barrett's epithelium, compared with 7 of 28 without fundoplication (P = 0.03). Of patients without fundoplication, those who had persistent or recurrent Barrett's had median Barrett's length of 10 cm (6-12 cm) compared with 3 cm (2-5 cm) in patients who had ablated Barrett's (P = 0.03). Follow-up length was similar in those with ablated epithelium, 15 months (12-19 months), compared with those with persistent or recurrent Barrett's, 12 months (12-13 months) (P = NS). CONCLUSIONS: Patients who had fundoplication in conjunction with endoluminal radiofrequency ablation were more likely to achieve durable ablation compared with patients who were treated with proton pump inhibitor therapy. It appears that patients with long-segment Barrett's esophagus are at higher risk for persistent or recurrent Barrett's metaplasia. Consideration should be given for an antireflux operation in patients with long-segment Barrett's esophagus and planned endoluminal radiofrequency ablation. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/20676687/Effects_of_Nissen_fundoplication_on_endoscopic_endoluminal_radiofrequency_ablation_of_Barrett's_esophagus_ L2 - https://dx.doi.org/10.1007/s00464-010-1270-0 DB - PRIME DP - Unbound Medicine ER -