ENDOSCOPIC ABLATION COMBINED WITH FUNDOPLICATION PLUS ACID SUPPRESSION-DUODENAL DIVERSION PROCEDURE FOR LONG SEGMENT BARRETT´S ESOPHAGUS: EARLY AND LONG-TERM OUTCOME
Italo Braghetto, Héctor Valladares, Enrique Lanzarini, Maher Musleh, Attila Csendes, Manuel Figueroa-Giralt, Owen Korn
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引用次数: 0
Abstract
ABSTRACT BACKGROUND: The addition of endoscopic ablative therapy plus proton pump inhibitors or fundoplication is postulated for the treatment of patients with long-segment Barrett´s esophagus (LSBE); however, it does not avoid acid and bile reflux in these patients. Fundoplication with distal gastrectomy and Roux-en-Y gastrojejunostomy is proposed as an acid suppression-duodenal diversion procedure demonstrating excellent results at long-term follow-up. There are no reports on therapeutic strategy with this combination. AIMS: To determine the early and long-term results observed in LSBE patients with or without low-grade dysplasia who underwent the acid suppression-duodenal diversion procedure combined with endoscopic therapy. METHODS: Prospective study including patients with endoscopic LSBE using the Prague classification for circumferential and maximal lengths and confirmed by histological study. Patients were submitted to argon plasma coagulation (21) or radiofrequency ablation (31). After receiving treatment, they were monitored at early and late follow-up (5–12 years) with endoscopic and histologic evaluation. RESULTS: Few complications (ulcers or strictures) were observed after the procedure. Re-treatment was required in both groups of patients. The reduction in length of metaplastic epithelium was significantly better after radiofrequency ablation compared to argon plasma coagulation (10.95 vs 21.15 mms for circumferential length; and 30.96 vs 44.41 mms for maximal length). Intestinal metaplasia disappeared in a high percentage of patients, and histological long-term results were quite similar in both groups. CONCLUSIONS: Endoscopic procedures combined with fundoplication plus acid suppression with duodenal diversion technique to eliminate metaplastic epithelium of distal esophagus could be considered a good alternative option for LSBE treatment.
背景:内镜下消融治疗加质子泵抑制剂或底扩术治疗长段巴雷特食管(LSBE);然而,它并不能避免这些患者的酸和胆汁反流。胃底吻合与远端胃切除术和Roux-en-Y胃空肠吻合术被认为是一种抑酸-十二指肠分流手术,在长期随访中显示出良好的效果。目前还没有关于这种联合治疗策略的报道。目的:确定有或无低度发育不良的LSBE患者在接受胃酸抑制-十二指肠分流术联合内镜治疗后的早期和长期结果。方法:前瞻性研究包括内镜下LSBE患者,采用布拉格分级法确定周长度和最大长度,并经组织学研究证实。21例患者接受氩等离子凝固治疗,31例患者接受射频消融治疗。接受治疗后,在早期和晚期随访(5-12年)进行内窥镜和组织学评估。结果:术后并发症(溃疡或狭窄)少。两组患者均需再次治疗。与氩等离子凝固相比,射频消融后化生上皮长度的减少明显更好(10.95 vs 21.15 mm);最大长度30.96 vs 44.41 MMS)。肠化生消失的比例很高,两组长期组织学结果相当相似。结论:内镜下手术联合食管底叠加抑酸十二指肠分流术消除食管远端化生上皮是治疗LSBE的良好选择。