Department of Esophagogastric Surgery, Hospital for Digestive Surgery, School of Medicine, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
Serbian Academy of Sciences and Arts, Beograd, Serbia.
Sci Rep. 2024 Nov 21;14(1):28895. doi: 10.1038/s41598-024-80081-2.
Radiofrequency ablation (RFA) is effective treatment for Barrett's esophagus (BE). Product of successful RFA is neosquamous epithelium (NSE), which resembles native squamous epithelium and has lower risk for neoplastic transformation. Dilated intercellular spaces (IS) are common microscopic feature of reflux induced injury of esophagus. The aim of this study was to analyze the ultrastructure of NSE by transmission electron microscopy (TEM), depending on the post RFA treatment modalities and to asses impact of these findings on BE recurrence. Prospective observational clinical study based on TEM analysis of biopsy of specimens obtained from patients in whom CE of BE was achieved minimum 6 months after the last RFA session. In each patient biopsies were taken from NSE and proximal esophagus. Two groups of patients were defined according to the post RFA treatment: proton pump inhibitors (PPI's) or laparoscopic Nissen fundoplication (LNF). Comparative analysis of IS length was made between two groups. Endoscopic surveillance with biopsies was conducted for 5 years. Overall 22 patients with CE of BE after RFA underwent complete study protocol, out of whom in 10 LNF was performed, while 12 were treated with PPI's. The mean values of IS length in the proximal esophagus and NSE in LNF group were 0.378 ± 0.116 µm and 0.878 ± 0.354, while in PPI's group 0.724 ± 0.325 µm and 1.228 ± 0.226 µm, respectively. Mean lenghts of IS were statistically significantly higher in PPI's group both in NSE (p = 0.032) and proximal esophagus (p = 0.009). There were 5 BE recurrences after 5 years surveillance, 4 in PPI group and 1 in LNF group, without statistical significance (p = 0.084). Dilated IS are commonly presented in NSE of patients with CE of BE with RFA who are treated with PPI's. LNF provides may offer better reflux protection of NSE than PPI's and may reduce the rates of recurrence after successful RFA treatment.
射频消融（RFA）是治疗 Barrett 食管（BE）的有效方法。RFA 的成功产物是新生鳞状上皮（NSE），它类似于天然鳞状上皮，发生肿瘤转化的风险较低。扩张的细胞间隙（IS）是食管反流损伤的常见微观特征。本研究的目的是通过透射电子显微镜（TEM）分析 RFA 后治疗方式对 NSE 超微结构的影响，并评估这些发现对 BE 复发的影响。这是一项基于 TEM 分析的前瞻性观察性临床研究，研究对象为至少在最后一次 RFA 治疗后 6 个月 BE 完全缓解的患者。在每位患者中，均从 NSE 和食管近端获取活检标本。根据 RFA 后治疗方法（质子泵抑制剂（PPI）或腹腔镜 Nissen 胃底折叠术（LNF））将患者分为两组。对两组患者的 IS 长度进行了比较分析。对患者进行了 5 年的内镜监测和活检。共有 22 例 RFA 后 BE 患者完成了完整的研究方案，其中 10 例行 LNF，12 例行 PPI 治疗。LNF 组食管近端和 NSE 的 IS 长度平均值分别为 0.378 ± 0.116 µm 和 0.878 ± 0.354，而 PPI 组分别为 0.724 ± 0.325 µm 和 1.228 ± 0.226 µm。PPI 组 NSE（p=0.032）和食管近端（p=0.009）的 IS 长度均显著高于 PPI 组。5 年后的内镜监测发现 5 例 BE 复发，其中 PPI 组 4 例，LNF 组 1 例，但无统计学意义（p=0.084）。在接受 PPI 治疗的 RFA 治疗后 BE 患者的 NSE 中，扩张的 IS 通常存在。LNF 可能比 PPI 提供更好的 NSE 反流保护，并可能降低 RFA 治疗成功后的复发率。
