Correction of cardioesophageal transition as a stage of treatment after endoscopic welding of esophageal metaplasia

Abstract

Annotation. Barrett’s esophagus is an acquired condition that develops as a result of the replacement of normal stratified squamous epithelium in the lower part of the esophagus by columnar epithelium. Barrett’s esophagus is considered a complication of gastroesophageal reflux disease (GERD). It has been shown and proven that various endoscopic methods are successful in treating this condition. However, long-term success in preventing further metaplasia and dysplasia is incompletely studied. Biological welding – controlled action of high frequency current on living tissues. It is used to stop gastrointestinal bleeding, ablation of small intestinal metaplasia of the esophageal mucosa. The aim of this study was to evaluate the success of endoscopic treatments for Barrett's esophagus and the need for further surgery in patients with GERD complicated by Barrett’s esophagus. Patients with Barrett’s esophagus C1-3M2-4 (Prague classification 2004) and severe dysplasia without nodule, as well as confirmed GERD without esophageal hernia were included. A total of 98 patients were included in the study, of whom 89 were re-consulted and examined after primary Barrett's esophageal ablation. Endoscopic treatment was performed by argon-plasma coagulation (APC) and high-frequency welding of living tissues (HFW). In the dynamics of patients were re-examined. Patients with recurrent metaplasia and a high DeMeester index (˃100) underwent antireflux surgery – crurography (if necessary) and Nissen fundoplication with a soft and short cuff. Recurrence of small bowel metaplasia was recorded in 15 patients. 12 patients underwent a two-stage treatment: first a second session of esophageal ablation, and in the second stage - antireflux surgery. 2 patients refused surgical treatment and underwent only the second session of ablation. All patients received drug therapy – prokinetics and proton pump inhibitors. Three months after surgery, pH metry was performed again, which showed normalization of the DeMeester index, as a result of which patients had no complaints such as heartburn, chest pain, dysphagia, which significantly improved their quality of life. Esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus according to the Seattle protocol was also performed. After examination of the histological material of metaplasia zones were not recorded. It is concluded that antireflux surgery is required as part of Barrett’s esophageal treatment to prevent further dysplasia and the development of esophageal cancer.