Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD

• Published in: Gastrointestinal endoscopy Vol. 53; no. 4; pp. 407 - 415
• Main Authors: Triadafilopoulos, George, DiBaise, John K., Nostrant, Timothy T., Stollman, Neil H., Anderson, Paul K., Edmundowicz, Steven A., Castell, Donald O., Kim, Michael S., Rabine, John C., Utley, David S.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2001; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Catheterization; Diseases of the digestive system; Energy Transfer; Esophagogastric Junction - chemistry; Female; Gastroesophageal Reflux - prevention & control; Gastroesophageal Reflux - therapy; Heartburn - diagnosis; Humans; Hydrogen-Ion Concentration; Male; Medical sciences; Middle Aged; Quality of Life; Radio Waves - adverse effects; Radio Waves - therapeutic use; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Human; Gastroesophageal reflux; Treatment efficiency; Multicenter study; Esophageal disease; Radiofrequency; Quality of life; Energy; Secondary effect; Digestive diseases; Feasibility; Endoscopy; Technique
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2001.112843

Background: In this multi-center study, the feasibility, safety, and efficacy of radiofrequency (RF) energy delivery to the gastroesophageal junction (GEJ) for the treatment of gastroesophageal reflux disease (GERD) were investigated. Methods: 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 by 24-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-form health survey (SF-36). Anti-secretory medications were withdrawn 7 days before each assessment of symptoms and pH/motility study. Medication use, endoscopic findings, esophageal acid exposure, and motility were assessed at 0 and 6 months. Results: Thirty-two men and 15 women underwent treatment. At 6 months there were improvements in the median heartburn score (4 to 1, p ≤ 0.0001), GERD score (26 to 7, p ≤ 0.0001), satisfaction (1 to 4, p ≤ 0.0001), mental SF-36 (46.2 to 55.5, 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. There was no significant change in median lower esophageal sphincter pressure (14.0 to 12.0 mm Hg, p = 0.19), peristaltic amplitude (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 after 3 weeks). Conclusion: 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. (Gastrointest Endosc 2001;53:407-15.)