TY - JOUR
T1 - Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD
AU - Triadafilopoulos, George
AU - DiBaise, John K.
AU - Nostrant, Timothy T.
AU - Stollman, Neil H.
AU - Anderson, Paul K.
AU - Edmundowicz, Steven A.
AU - Castell, Donald O.
AU - Kim, Michael S.
AU - Rabine, John C.
AU - Utley, David S.
PY - 2001/4
Y1 - 2001/4
N2 - In this multi-center study, the feasibility, safety, and efficacy of radiofrequency (RF) energy delivery to thegastroesophageal 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 by24-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-formhealth survey (SF-36). Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motilitystudy. 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 to1, p≤ 0.0001), GERD score (26 to 7, p ≤ 0.0001), satisfaction (1 to 4, p ≤ 0.0001), mental SF-36 (46.2 to55.5, 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. Ther was no significant change in median lower esophageal sphincter pressure (14.0 to 12.0 mm Hg, p = 0.19), peristalticamplitude (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 after3 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.
AB - In this multi-center study, the feasibility, safety, and efficacy of radiofrequency (RF) energy delivery to thegastroesophageal 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 by24-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-formhealth survey (SF-36). Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motilitystudy. 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 to1, p≤ 0.0001), GERD score (26 to 7, p ≤ 0.0001), satisfaction (1 to 4, p ≤ 0.0001), mental SF-36 (46.2 to55.5, 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. Ther was no significant change in median lower esophageal sphincter pressure (14.0 to 12.0 mm Hg, p = 0.19), peristalticamplitude (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 after3 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.
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U2 - 10.1067/mge.2001.112843
DO - 10.1067/mge.2001.112843
M3 - Article
C2 - 11275878
AN - SCOPUS:0035318370
SN - 0016-5107
VL - 53
SP - 407
EP - 415
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -