Radiofrequency energy delivered to the gastroesophageal junction for the treatment of GERD

被引:117
作者
Triadafilopoulos, G
DiBaise, JK
Nostrant, TT
Stollman, NH
Anderson, PK
Edmundowicz, SA
Castell, DO
Kim, MS
Rabine, JC
Utley, DS
机构
[1] VA Palo Alto Hlth Care Syst, Gastroenterol Sect, Palo Alto, CA 94304 USA
[2] VA Palo Alto Hlth Care Syst, Otolaryngol Head & Neck Surg Sect, Palo Alto, CA 94304 USA
[3] Stanford Univ, Sch Med, Stanford, CA 94305 USA
[4] Univ Nebraska, Dept Med, Div Gastroenterol, Omaha, NE 68182 USA
[5] Univ Michigan Hosp, Dept Med, Div Gastroenterol, Ann Arbor, MI 48109 USA
[6] Univ Miami, Miami VA Med Ctr, Dept Med, Div Gastroenterol, Miami, FL 33152 USA
[7] Dallas Diagnost Associates, Dept Med, Div Gastroenterol, Dallas, TX USA
[8] Grad Hosp Philadelphia, Dept Med, Div Gastroenterol, Philadelphia, PA 19146 USA
关键词
D O I
10.1067/mge.2001.112843
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: In this multi-center study, the feasibility, safety, and efficiency of radiofrequency (RF) energy delivery to the gastroesophageal junction (GEJ) for the treatment of gastroesophageal reflux disease (GERD) were investigated. Methods: Forty-seven patients with classic symptoms of GERD (heartburn and/or regurgitation), a daily anti-secretory medication requirement, and at least partial symptom response to drugs were enrolled. All patients had pathologic esophageal acid exposure by 24-hour pH study, a 2 cm or smaller hiatal hernia, grade 2 or less esophagitis, and no significant dysmotility of dysphagia. RF energy was delivered with a catheter and thermocouple-controlled generator to create submucosal thermal lesions in the muscle of the GEJ. GERD symptoms and quality of life were assessed at 0, 1, 4, and 6 months with short-form health survey (SF-36). Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motility study. Medication use, endoscopic findings, esophageal acid exposure, and motility were assessed at 0 and 6 months. Results: Thirty-two men and 15 women underwent treatment. At 6 months there were improvements in the median heartburn score (4 to 1, p less than or equal to 0.0001), GERD score (26 to 7, p less than or equal to 0.0001), satisfaction (1 to 4, p less than or equal to 0.0001), mental SF-36 (46.2 to 55.5, p less than or equal to 0.01), physical SF-36 (41.1 to 51.9, p less than or equal to 0.0001), and esophageal acid exposure (11.7% to 4.8%, p less than or equal to 0.0001). Esophagitis was present in 25 patients before treatment (15 grade 1 and 10 grade 2) and 8 had esophagitis at 6 months (4 grade 1 and 4 grade 2, p less than or equal to 0.005). At 6 months, 87% no longer required proton pump inhibitor medication. There was no significant change in median lower esophageal sphincter pressure (14.0 to 12.0 mm Hg, p = 0.19), peristaltic amplitude (64 to 666 mm Hg, p = 0.71), or lower esophageal sphincter length (3.0 to 3.0, p = 0.28). There were 3 self-limited complications (fever for 24 hours, odynophagia lasting for 5 days, and a linear mucosal injury that was healed after 3 weeks). Conclusion: RF energy delivery significantly improved GERD symptoms, quality of life, and esophageal acid exposure while eliminating the need for anti-secretory medication in the majority of patients of patients with a heterogenous spectrum of clinical disease severity but with minimal active esophagitis or hiatal hernia.
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页码:407 / 415
页数:9
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