Hubbard N, Velanovich V
Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, Michigan 48202-2689, USA.
Surg Endosc. 2007 Apr;21(4):625-8. doi: 10.1007/s00464-007-9199-7. Epub 2007 Feb 16.
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.
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.
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.
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.
使用巴瑞克斯（Barrx）设备进行内镜腔内射频消融术是治疗巴雷特食管的一项新技术。该手术已应用于未接受过抗反流手术的患者。本报告介绍了腔内消融术对胃底折叠术后患者反流症状及消融完整性影响的早期经验。
7例接受过腹腔镜或开放尼森胃底折叠术及患有巴雷特食管的患者，使用巴瑞克斯设备（Barrx Medical，加利福尼亚州森尼韦尔市）对巴雷特化生进行内镜腔内消融。术前，所有患者均无与胃食管反流病相关的明显症状。消融术后1至2周，询问患者症状情况。术前及术后，患者完成胃食管反流病健康相关生活质量（GERD-HRQL）症状严重程度问卷（最佳得分为0分；最差得分为50分）。患者在初始治疗3个月后接受随访内镜检查以评估消融的完整性。
所有患者均完成消融，无并发症发生。无患者报告胃食管反流病症状复发。术前GERD-HRQL总评分中位数为2分，术后中位数为1分。1例患者在3个月随访时有残余巴雷特化生，需要再次消融。
这份关于少数患者的初步报告表明，对于已经接受过抗反流手术的患者，使用巴瑞克斯设备对巴雷特化生进行内镜腔内消融是安全有效的。胃底折叠术似乎未受影响，也未出现胃食管反流病相关症状复发。然而，需要对更多患者进行长期随访。
