Bremner R M, Mason R J, Bremner C G, DeMeester T R, Chandrasoma P, Peters J H, Hagen J A, Gadenstätter M
Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA 90033-4612, USA.
Surg Endosc. 1998 Apr;12(4):342-6; discussion 346-7. doi: 10.1007/s004649900667.
The premalignant potential of Barrett's esophagus has stimulated efforts to find a way to ablate the columnar epithelium in order to reheal the area with squamous epithelium, thus obviating the cancer risk. This study describes and evaluates a new technique using ultrasonic energy to ablate the epithelium of the lower esophagus in a porcine model.
Eight young farm pigs were used to develop the technique of applying a laparoscopic Cavitron Ultrasonic Surgical Aspirator (CUSA) to the lower esophageal mucosa through an operating gastrostomy. A further 11 Yakutan minipigs then underwent CUSA epithelial ablation, followed by a laparoscopic Nissen fundoplication or postoperative acid suppression therapy. We then assessed the healing response in these subjects.
Optimal CUSA energy settings enabled complete ablation of the squamous epithelium with preservation of the muscularis mucosa and submucosa. The integrity of the aspirated cells was sufficient for cytological analysis. Healing occurred by squamous regeneration without stricture formation.
The CUSA technique holds promise for complete ablation of the Barrett's epithelium in a single setting. The unique tissue-selective nature of the ablative process allows complete mucosal reepithelialization without stricture formation.
巴雷特食管的癌前病变潜能促使人们努力寻找一种方法来消融柱状上皮，以便用鳞状上皮重新修复该区域，从而消除癌症风险。本研究描述并评估了一种在猪模型中使用超声能量消融食管下段上皮的新技术。
使用8只年轻的农场猪来开发通过手术胃造口术将腹腔镜超声手术吸引器（CUSA）应用于食管下段黏膜的技术。另外11只雅库坦小型猪随后接受了CUSA上皮消融，接着进行了腹腔镜尼森胃底折叠术或术后抑酸治疗。然后我们评估了这些受试者的愈合反应。
最佳的CUSA能量设置能够完全消融鳞状上皮，同时保留黏膜肌层和黏膜下层。吸出细胞的完整性足以进行细胞学分析。通过鳞状上皮再生实现愈合，未形成狭窄。
CUSA技术有望在单次操作中完全消融巴雷特上皮。消融过程独特的组织选择性特性允许完全的黏膜重新上皮化且不形成狭窄。
