Long-term results of ablation with antireflux surgery for Barrett’s esophagus: a clinical and molecular biologic study

Kauttu, Tuuli; Räsänen, Jari; Krogerus, Leena; Sihvo, Eero; Puolakkainen, Pauli; Salo, Jarmo A.

doi:10.1007/s00464-011-2121-3

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…Post-procedure mortality is not reported 23 . The results observed in the present study comparing APC and RFA are in accordance with other publications 2 , 30 , 34 , 43 .…”

Section: Discussionsupporting

confidence: 93%

Endoscopic Ablation Combined With Fundoplication Plus Acid Suppression-Duodenal Diversion Procedure for Long Segment Barrett´s Esophagus: Early and Long-Term Outcome

Braghetto,

Valladares,

Lanzarini

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: The addition of endoscopic ablative therapy plus proton pump inhibitors or fundoplication is postulated for the treatment of patients with long-segment Barrett´s esophagus (LSBE); however, it does not avoid acid and bile reflux in these patients. Fundoplication with distal gastrectomy and Roux-en-Y gastrojejunostomy is proposed as an acid suppression-duodenal diversion procedure demonstrating excellent results at long-term follow-up. There are no reports on therapeutic strategy with this combination. AIMS: To determine the early and long-term results observed in LSBE patients with or without low-grade dysplasia who underwent the acid suppression-duodenal diversion procedure combined with endoscopic therapy. METHODS: Prospective study including patients with endoscopic LSBE using the Prague classification for circumferential and maximal lengths and confirmed by histological study. Patients were submitted to argon plasma coagulation (21) or radiofrequency ablation (31). After receiving treatment, they were monitored at early and late follow-up (5–12 years) with endoscopic and histologic evaluation. RESULTS: Few complications (ulcers or strictures) were observed after the procedure. Re-treatment was required in both groups of patients. The reduction in length of metaplastic epithelium was significantly better after radiofrequency ablation compared to argon plasma coagulation (10.95 vs 21.15 mms for circumferential length; and 30.96 vs 44.41 mms for maximal length). Intestinal metaplasia disappeared in a high percentage of patients, and histological long-term results were quite similar in both groups. CONCLUSIONS: Endoscopic procedures combined with fundoplication plus acid suppression with duodenal diversion technique to eliminate metaplastic epithelium of distal esophagus could be considered a good alternative option for LSBE treatment.

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“…Post-procedure mortality is not reported 23 . The results observed in the present study comparing APC and RFA are in accordance with other publications 2 , 30 , 34 , 43 .…”

Section: Discussionsupporting

confidence: 93%

Endoscopic Ablation Combined With Fundoplication Plus Acid Suppression-Duodenal Diversion Procedure for Long Segment Barrett´s Esophagus: Early and Long-Term Outcome

Braghetto,

Valladares,

Lanzarini

et al. 2023

ABCD, arq. bras. cir. dig.

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“…47 48 However, oxidative stress remains high after ablation, as evidenced by higher levels of 8OHdG and superoxide dismutase activity. 49 Functionally, the barrier function of the neo-squamous epithelium is suboptimal; its electrical resistance has been demonstrated to be significantly lower than that of normal oesophagus, and equivalent to GERD. 50 Therefore, strengthening the neo-squamous epithelium with an Nrf2 activator may be a potential solution.…”

Section: Discussionmentioning

confidence: 99%

Nrf2 deficiency impairs the barrier function of mouse oesophageal epithelium

Chen

et al. 2013

Gut

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Objective As a major cellular defense mechanism, the Nrf2/Keap1 pathway regulates expression of genes involved in detoxification and stress response. Our previous study revealed activation of the Nrf2/Keap1 pathway at the maturation phase during mouse esophageal development, suggesting a potential function in epithelial defense. Here we hypothesize that Nrf2 is involved in the barrier function of esophageal epithelium, and plays a protective role against gastroesophageal reflux disease (GERD). Design Human esophageal biopsy samples, mouse surgical models and Nrf2-/- mice were used to assess the role of the Nrf2/Keap1 pathway in esophageal mucosal barrier function. Trans-epithelial electrical resistance (TEER) was measured with mini-Ussing chambers. Hematoxylin and eosin (HE) staining and transmission electron microscopy were used to examine cell morphology, while gene microarray, immunohistochemistry, Western blotting and ChIP analysis were used to assess the expression of pathway genes. Results Nrf2 was expressed in normal esophageal epithelium and activated in GERD of both humans and mice. Nrf2 deficiency and gastroesophageal reflux in mice, either alone or in combination, reduced TEER and increased intercellular space diameter in esophageal epithelium. Nrf2 target genes and gene sets associated with oxidoreductase activity, mitochondrial biogenesis and energy production were down-regulated in the esophageal epithelium of Nrf2-/- mice. Consistent with the antioxidative function of Nrf2, a DNA oxidative damage marker (8OHdG) dramatically increased in esophageal epithelial cells of Nrf2-/- mice compared with those of wild-type mice. Interestingly, ATP biogenesis, Cox IV (a mitochondrial protein) and Claudin-4 (Cldn4) expression were down-regulated in the esophageal epithelium of Nrf2-/- mice, suggesting that energy-dependent tight junction integrity was subject to Nrf2 regulation. ChIP analysis confirmed the binding of Nrf2 to Cldn4 promoter. Conclusion Nrf2 deficiency impairs esophageal barrier function through disrupting energy-dependent tight junction. Elucidating the role of this pathway in GERD has potential implications for the pathogenesis and therapy of the disease.

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“…De allí surge la posibilidad de someter a estos pacientes a ablación con argón plasma por vía endoscópica para disminuir este riesgo de desarrollar un adenocarcinoma [1][2][3][4][5] . Recientemente se ha descrito la restauración parcial de la mucosa escamosa después de la ablación de EB con técnicas endoscópicas 6,7 .…”

Section: Seguimiento Endoscópico E Histológico Post Ablación Con Argóunclassified

Seguimiento Endoscópico E Histológico Post Ablación Con Argón Plasma Del Esófago De Barrett Extenso en Pacientes Sometidos a Tratamiento Quirúrgico Previo

Valladares

et al. 2014

Rev Chil Cir

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Argon plasma ablation of extensive Barrett esophagus. Experience in 19 patientsBackground: Endoscopic argon plasma ablation of Barrett esophagus decreases the risk of future esophageal cancer development. aim: To assess the endoscopic regression of columnar epithelium and the presence of intestinal metaplasia among patients operated for Barrett esophagus and subjected to argon plasma ablation. Patients and methods: In 19 patients with extensive Barrett esophagus subjected to a nissen fundoplication, Barrett esophagus was endoscopically ablated with argon plasma. Patients were assessed 6 and 12 months after surgery to evaluate the regression of columnar epithelium and the presence of intestinal metaplasia. results: One, two and three ablation sessions were carried out in 10, three and six patients, respectively. Three patients had complications. The initial length of columnar epithelium segment was 52 ± 15.6 mm and decreased to 22.6 ± 10.6 mm (p < 0.05). In 12 patients, there was absence of intestinal metaplasia on follow up, in six it persisted (one of them with "buried cells") and in one patient, dysplasia appeared. conclusions: Endoscopic argon plasma ablation may have a complementary therapeutic role for the regression of columnar epithelium in Barrett esophagus.

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Long-term results of ablation with antireflux surgery for Barrett’s esophagus: a clinical and molecular biologic study

Cited by 6 publications

References 30 publications

Endoscopic Ablation Combined With Fundoplication Plus Acid Suppression-Duodenal Diversion Procedure for Long Segment Barrett´s Esophagus: Early and Long-Term Outcome

Endoscopic Ablation Combined With Fundoplication Plus Acid Suppression-Duodenal Diversion Procedure for Long Segment Barrett´s Esophagus: Early and Long-Term Outcome

Nrf2 deficiency impairs the barrier function of mouse oesophageal epithelium

Seguimiento Endoscópico E Histológico Post Ablación Con Argón Plasma Del Esófago De Barrett Extenso en Pacientes Sometidos a Tratamiento Quirúrgico Previo

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