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

George Triadafilopoulos, John K. DiBaise, Timothy T. Nostrant, Neil H. Stollman, Paul K. Anderson, Steven A. Edmundowicz, Donald O. Castell, Michael S. Kim, John C. Rabine, David S. Utley

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

In this multi-center study, the feasibility, safety, and efficacy of radiofrequency (RF) energy delivery to the gastroesophageal junction (GEJ) for the treatment of gastroesophageal reflux disease (GERD) were investigated. 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 or 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 the 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 Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motility study.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. Thirty-two men and 15 women underwent treatment. At 6 months there were improvements in the median heartburn score (4 to 1, p ≤ 0.0001), GERD score (26 to 7, p ≤ 0.0001), satisfaction (1 to 4, p ≤ 0.0001), mental SF-36 (46.2 to 55.5, p = 0.01), physical SF-36 (41.1 to 51.9, p ≤ 0.0001), and esophageal acid exposure (11.7% to 4.8%, p ≤ 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 = 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 66 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). 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 with a heterogeneous spectrum of clinical disease severity but with minimal active esophagitis or hiatal hernia.

Original languageEnglish (US)
Pages (from-to)407-415
Number of pages9
JournalGastrointestinal Endoscopy
Volume53
Issue number4
DOIs
StatePublished - Apr 2001
Externally publishedYes

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Esophagogastric Junction
Gastroesophageal Reflux
Esophagitis
Heartburn
Lower Esophageal Sphincter
Hiatal Hernia
Acids
Quality of Life
Therapeutics
Symptom Assessment
Proton Pump Inhibitors
Deglutition Disorders
Health Surveys
Fever
Catheters
Hot Temperature
Safety
Pressure
Muscles
Wounds and Injuries

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Triadafilopoulos, G., DiBaise, J. K., Nostrant, T. T., Stollman, N. H., Anderson, P. K., Edmundowicz, S. A., ... Utley, D. S. (2001). Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointestinal Endoscopy, 53(4), 407-415. https://doi.org/10.1067/mge.2001.112843

Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. / Triadafilopoulos, George; DiBaise, John K.; Nostrant, Timothy T.; Stollman, Neil H.; Anderson, Paul K.; Edmundowicz, Steven A.; Castell, Donald O.; Kim, Michael S.; Rabine, John C.; Utley, David S.

In: Gastrointestinal Endoscopy, Vol. 53, No. 4, 04.2001, p. 407-415.

Research output: Contribution to journalArticle

Triadafilopoulos, G, DiBaise, JK, Nostrant, TT, Stollman, NH, Anderson, PK, Edmundowicz, SA, Castell, DO, Kim, MS, Rabine, JC & Utley, DS 2001, 'Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD', Gastrointestinal Endoscopy, vol. 53, no. 4, pp. 407-415. https://doi.org/10.1067/mge.2001.112843
Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Edmundowicz SA et al. Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointestinal Endoscopy. 2001 Apr;53(4):407-415. https://doi.org/10.1067/mge.2001.112843
Triadafilopoulos, George ; DiBaise, John K. ; Nostrant, Timothy T. ; Stollman, Neil H. ; Anderson, Paul K. ; Edmundowicz, Steven A. ; Castell, Donald O. ; Kim, Michael S. ; Rabine, John C. ; Utley, David S. / Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. In: Gastrointestinal Endoscopy. 2001 ; Vol. 53, No. 4. pp. 407-415.
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