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S1498: Short Term Outcomes of Concomittant Antireflux Surgery With BARRx Ablation for Barrett's Esophagus
Abstracts extrinsic esophageal compression. In spite of the short survival, some patients present with recurrent dysphagia, which can be dealt with effectively by endoscopic reintervention.
S1498 Short Term Outcomes of Concomittant Antireflux Surgery With BARRx Ablation for Barrett’s Esophagus Pedro A. Lea˜o, Trudie A. Goers, Richard A. Pierce, Christy M. Dunst, Lee L. Swanstrom Background:There is no consensus regarding the ideal treatment of Barretts esophagus (BE). Barrets radiofrequency ablation (BRFA) has been shown to be a safe and effective treatment for patients with BE. Protocols vary with regard to indications, and to the best post-procedure treatment. In particular, the timing of treatment for Barretts patients who would benefit from anti-reflux procedures (ARS) remains in debate. Theoretically, ARS is an ideal treatment adjunct for BRFA patients. However, ablating reflux patients with large hiatal hernias or dilated esophagus can be challenging and ineffective due to the irregular anatomy. However, there is concern about using BRFA following fundoplication due to possible difficulty ablating within the wrap and unknown effects on the repair. We hypothesize that BRFA and ARS can be safely performed concomitantly to reduce the need for additional intervention and possibly improve the effectiveness of the ablation. Methods:This study involved the retrospective review of patient charts and information that was prospectively collected for an IRB-approved data registry containing patients who had BRFA therapy. Patients included in this study underwent ARS with intraoperative BRFA. Indications were need for both Barretts ablation and ARS or inability to effectible ablates due to anatomic distortion of the esophagus. Patient demographics, Barretts physical and histological characteristics, pre-procedure and postprocedure endoscopic findings, procedural data, complications, length of hospital stay and post-operative events were analyzed. Results:Nine patients underwent BRFA at the time of laparoscopic ARS. The mean length of BE present was 6cm(1-13). Ablation was performed with 360(66.6%) and 90(33.3%) devices. The average number of ablations delivered was 5 for 360 and 6.5 for 90 devices. The mean operation time was 152min(65-226min) and patients on average were discharged on post-operative day 2. One stricture and 1delayed perforation were the observed complications. At 3 months, 40% had complete resolution of their BE lesions while 60%(15-50% Barretts residual) only had partial resolution. Conclusion:Intra-operative BRFA is feasible and offers patients the benefit of a single combined treatment with possibly more effective ablation of their BE. Some works reports a complication rate of 26%(stenoses), including 2.7%(perforations), performing intraoperative BRFA in this study resulted in an observed complication rate of 22.2%. While these complications were conservatively managed and patients ultimately did well, this is concerning and we now limit our intraoperative therapy to the ablation of 5cm of BE or less.
S1499 Procedural Trends in Endoscopic Ablation and Resection for Esophageal Dysplasia and Carcinoma Lois L. Hemminger, Abraham M. Panossian, Courtney Duran, Massimo Raimondo, Timothy A. Woodward, Michael B. Wallace, Herbert C. Wolfsen IntroductionPatients with Barrett’s dysplasia and early neoplasia are increasingly referred for endoscopic resection and ablation. The aim of this study was to describe these procedural trends in a large group practice.MethodsThe medical records were reviewed for all patients undergoing endoscopic therapy each calendar year for Barrett’s dysplasia and early carcinoma including patient demographics, grade of histologic disease and number and type of mucosal resection using either band ligation, inject and snare or cap technique (EMR) and ablation (porfimer sodium photodynamic therapy {Ps-PDT}, liquid nitrogen spray cryotherapy {LNC}, focal and circumferential balloon catheter radiofrequency ablation {RFA-90 and RFA-360, respectively}). ResultsThe number of resection and ablation procedures increased from 61 in 2005 to 381 thus far in 2009 (see Graph). We have seen dramatic increases in all forms of mucosal resection and ablation, particularly RFA-90 procedures. ConclusionThe number of endoscopic procedures for Barrett’s disease including dysplasia and early carcinoma has increased dramatically over the past 5 years, including a nearly ten-fold increase in EMR and a more than five-fold increase in ablation procedures. The decrease in Ps-PDT cases has been balanced by progressive increases in RFA-360 and LNCryo procedures. The largest increase, however, has come from the use of RFA-90 for treatment of residual and short segment disease.
AB178 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
S1500 Gatekeeper Reflux Repair System for Severe GERD: Results of Five Years Follow-up Francesca Picconi, Francesco M. Di Matteo, Margareth Martino, Michele Cicala, Mentore Ribolsi, Guido Costamagna, Monica Pandolfi Introduction: many methods of endoscopic treatment (ET) of gastro-oesophageal reflux disease (GERD) have been studied in the last years. Most have disappeared from clinical practice, so that there are few data about ET long term follow-up. We report results, after a mean follow up of 5.4 years, of Gatekeeper Reflux Repair System (GRRS) (Medtronic Europe, Tolchenaz, Switzerland), which relies on submucosal implantation of expandable hydrogel prostheses at gastrooesophageal junction.Materials and Methods: 21 patients with severe GERD attested by functional tests and treated with GRRS from 2001 to 2006 were reviewed. All patients have been treated with intention to implant four prostheses at gastro-oesophageal junction. After procedure, the clinical response has been periodically verified. Early in 2008 we decided to revaluate these patients with a standardized questionnaire (GERD-HRQL), gastroscopy, endoscopic ultrasound (EUS), esophageal manometry and 24 hours impedance pH monitoring. Results: No significant morbidity and/or mortality were observed. One patient has been excluded from follow-up (he decided to undergo surgery though he had benefit from endoscopic procedure). In the remaining 20 patients, at 5.4 years of mean follow-up (range 17-87 months), 1 patient did not respond to treatment (5 %) while nineteen patients (95 %) showed a remarkable improvement of pharmacological habits: 15 patients (79%) were completely off therapy, while 4 patients (21 %) had significantly reduced drugs dose (⬎50%). In 12 patients who accepted to undergo functional revaluation, acid exposure time (AET) in distal esophagus decreased from a median basal value of 8.5% to 1.4%(p⫽0.002), resulting in the normal range in all patients, but one. LES basal mean pressure, increased from 11.07 mmHg to 17.78 mmHg (p⫽ns). In 13 patients (7 patients refused to fill the questionnaire) GERD-HRQL score significantly improved (p⫽0.005). At endoscopy we observed a prosthesis migration rate of 40%, but none of our patient was without prosthesis.Conclusion: GRRS has proved to be a safe and effective technique in a selected population. At more than 5-years follow up, more than 90% of patients showed subjective and objective improvement of GERD.
S1501 Prognostic Implications of High-Grade Malignant Esophageal Strictures in Esophageal Cancer Ramu P. Raju, Sathya Jaganmohan, Mehmet Bektas, Manoop S. Bhutani, Jeffrey H. Lee Background: High-grade malignant esophageal strictures (MES) limits esophageal cancer staging in 20-36% of the patients by precluding passage of the echoendoscope. Diagnostic options in this setting include limited EUS exam, use of ultrasound probes, or dilation of the stenosis to allow passage of a regular echoendoscope. Stricture dilation has been associated with a significant risk of perforation with uncertain benefitsObjective: To compare the predictive factors and outcomes associated with MES. Methods: Retrospective, chart review was performed on 50 patients with MES and 50 controls with non-obstructing esophageal cancer (NEC) who were identified from 1/1/05-12/31/08. All patients underwent multi-modality imaging including computed tomography (CT) scan, positron emission tomography (PET), and EUS and were pre-operatively staged
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S1498 Short Term Outcomes of Concomittant Antireflux Surgery With BARRx Ablation for Barrett’s Esophagus Pedro A. Lea˜o, Trudie A. Goers, Richard A. Pierce, Christy M. Dunst, Lee L. Swanstrom Background:There is no consensus regarding the ideal treatment of Barretts esophagus (BE). Barrets radiofrequency ablation (BRFA) has been shown to be a safe and effective treatment for patients with BE. Protocols vary with regard to indications, and to the best post-procedure treatment. In particular, the timing of treatment for Barretts patients who would benefit from anti-reflux procedures (ARS) remains in debate. Theoretically, ARS is an ideal treatment adjunct for BRFA patients. However, ablating reflux patients with large hiatal hernias or dilated esophagus can be challenging and ineffective due to the irregular anatomy. However, there is concern about using BRFA following fundoplication due to possible difficulty ablating within the wrap and unknown effects on the repair. We hypothesize that BRFA and ARS can be safely performed concomitantly to reduce the need for additional intervention and possibly improve the effectiveness of the ablation. Methods:This study involved the retrospective review of patient charts and information that was prospectively collected for an IRB-approved data registry containing patients who had BRFA therapy. Patients included in this study underwent ARS with intraoperative BRFA. Indications were need for both Barretts ablation and ARS or inability to effectible ablates due to anatomic distortion of the esophagus. Patient demographics, Barretts physical and histological characteristics, pre-procedure and postprocedure endoscopic findings, procedural data, complications, length of hospital stay and post-operative events were analyzed. Results:Nine patients underwent BRFA at the time of laparoscopic ARS. The mean length of BE present was 6cm(1-13). Ablation was performed with 360(66.6%) and 90(33.3%) devices. The average number of ablations delivered was 5 for 360 and 6.5 for 90 devices. The mean operation time was 152min(65-226min) and patients on average were discharged on post-operative day 2. One stricture and 1delayed perforation were the observed complications. At 3 months, 40% had complete resolution of their BE lesions while 60%(15-50% Barretts residual) only had partial resolution. Conclusion:Intra-operative BRFA is feasible and offers patients the benefit of a single combined treatment with possibly more effective ablation of their BE. Some works reports a complication rate of 26%(stenoses), including 2.7%(perforations), performing intraoperative BRFA in this study resulted in an observed complication rate of 22.2%. While these complications were conservatively managed and patients ultimately did well, this is concerning and we now limit our intraoperative therapy to the ablation of 5cm of BE or less.
S1499 Procedural Trends in Endoscopic Ablation and Resection for Esophageal Dysplasia and Carcinoma Lois L. Hemminger, Abraham M. Panossian, Courtney Duran, Massimo Raimondo, Timothy A. Woodward, Michael B. Wallace, Herbert C. Wolfsen IntroductionPatients with Barrett’s dysplasia and early neoplasia are increasingly referred for endoscopic resection and ablation. The aim of this study was to describe these procedural trends in a large group practice.MethodsThe medical records were reviewed for all patients undergoing endoscopic therapy each calendar year for Barrett’s dysplasia and early carcinoma including patient demographics, grade of histologic disease and number and type of mucosal resection using either band ligation, inject and snare or cap technique (EMR) and ablation (porfimer sodium photodynamic therapy {Ps-PDT}, liquid nitrogen spray cryotherapy {LNC}, focal and circumferential balloon catheter radiofrequency ablation {RFA-90 and RFA-360, respectively}). ResultsThe number of resection and ablation procedures increased from 61 in 2005 to 381 thus far in 2009 (see Graph). We have seen dramatic increases in all forms of mucosal resection and ablation, particularly RFA-90 procedures. ConclusionThe number of endoscopic procedures for Barrett’s disease including dysplasia and early carcinoma has increased dramatically over the past 5 years, including a nearly ten-fold increase in EMR and a more than five-fold increase in ablation procedures. The decrease in Ps-PDT cases has been balanced by progressive increases in RFA-360 and LNCryo procedures. The largest increase, however, has come from the use of RFA-90 for treatment of residual and short segment disease.
AB178 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
S1500 Gatekeeper Reflux Repair System for Severe GERD: Results of Five Years Follow-up Francesca Picconi, Francesco M. Di Matteo, Margareth Martino, Michele Cicala, Mentore Ribolsi, Guido Costamagna, Monica Pandolfi Introduction: many methods of endoscopic treatment (ET) of gastro-oesophageal reflux disease (GERD) have been studied in the last years. Most have disappeared from clinical practice, so that there are few data about ET long term follow-up. We report results, after a mean follow up of 5.4 years, of Gatekeeper Reflux Repair System (GRRS) (Medtronic Europe, Tolchenaz, Switzerland), which relies on submucosal implantation of expandable hydrogel prostheses at gastrooesophageal junction.Materials and Methods: 21 patients with severe GERD attested by functional tests and treated with GRRS from 2001 to 2006 were reviewed. All patients have been treated with intention to implant four prostheses at gastro-oesophageal junction. After procedure, the clinical response has been periodically verified. Early in 2008 we decided to revaluate these patients with a standardized questionnaire (GERD-HRQL), gastroscopy, endoscopic ultrasound (EUS), esophageal manometry and 24 hours impedance pH monitoring. Results: No significant morbidity and/or mortality were observed. One patient has been excluded from follow-up (he decided to undergo surgery though he had benefit from endoscopic procedure). In the remaining 20 patients, at 5.4 years of mean follow-up (range 17-87 months), 1 patient did not respond to treatment (5 %) while nineteen patients (95 %) showed a remarkable improvement of pharmacological habits: 15 patients (79%) were completely off therapy, while 4 patients (21 %) had significantly reduced drugs dose (⬎50%). In 12 patients who accepted to undergo functional revaluation, acid exposure time (AET) in distal esophagus decreased from a median basal value of 8.5% to 1.4%(p⫽0.002), resulting in the normal range in all patients, but one. LES basal mean pressure, increased from 11.07 mmHg to 17.78 mmHg (p⫽ns). In 13 patients (7 patients refused to fill the questionnaire) GERD-HRQL score significantly improved (p⫽0.005). At endoscopy we observed a prosthesis migration rate of 40%, but none of our patient was without prosthesis.Conclusion: GRRS has proved to be a safe and effective technique in a selected population. At more than 5-years follow up, more than 90% of patients showed subjective and objective improvement of GERD.
S1501 Prognostic Implications of High-Grade Malignant Esophageal Strictures in Esophageal Cancer Ramu P. Raju, Sathya Jaganmohan, Mehmet Bektas, Manoop S. Bhutani, Jeffrey H. Lee Background: High-grade malignant esophageal strictures (MES) limits esophageal cancer staging in 20-36% of the patients by precluding passage of the echoendoscope. Diagnostic options in this setting include limited EUS exam, use of ultrasound probes, or dilation of the stenosis to allow passage of a regular echoendoscope. Stricture dilation has been associated with a significant risk of perforation with uncertain benefitsObjective: To compare the predictive factors and outcomes associated with MES. Methods: Retrospective, chart review was performed on 50 patients with MES and 50 controls with non-obstructing esophageal cancer (NEC) who were identified from 1/1/05-12/31/08. All patients underwent multi-modality imaging including computed tomography (CT) scan, positron emission tomography (PET), and EUS and were pre-operatively staged
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