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

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Abstract

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 Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motilitystudy.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.

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

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Triadafilopoulos, G., DiBaise, J. K., Nostrant, T. T., Stollman, N. H., Anderson, P. K., Edmundowicz, S. A., Castell, D. O., Kim, M. S., Rabine, J. C., & 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