Barrett食管的冷冻消融术:一项先导性研究

作     者：Johnston M.H Eastone J.A Horwhat J.D. 尹勇 

作者机构：Gastroenterology GIClinicNationl Naval Medical Center 8901 Wisconsin Ave Bethesda MD 20889 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第4期

页      面：26-26页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Barrett 冷冻消融术 酸反流 早期食管癌 雷贝拉唑 不典型增生 喷洒液 操作时间 低温射频 胃 

摘      要：Background: Numerous ablative modalities have demonstrated varying degrees of efficacy in the eradication of Barrett‘s esophagus (BE). However, they are associated with either high cost, patient discomfort, complications, tedious applica tion, residual underlying BE, or some combination of the above. The aim of this study was to evaluate the safety and the efficacy of a new cryogenic device by u sing liquid nitrogen sprayed through an open tipped cryogenic catheter placed th rough the accessory channel of an upper endoscope. Methods: A prospective, singl e center studywas performed on patients with a long-standing history of BE foll owed in a Barrett‘s registry. Patients with degrees of dysplasia ranging from n one to multifocal high-grade dysplasia were treated. All patients were treated with 40 mg rabeprazole 3 times per day during the treatment period. Elimination of acid reflux was confirmed via 24-hour esophageal pH studies. Cryoablation wa s applied hemicircumferentially to 4-cm-long segments at monthly intervals, un til the entire segment of BE was eliminated. Results: Eleven patients were treat ed. There was reversal of BE in all patients. In 9 of 11 (78%) patients who com pleted the protocol, there was complete endoscopic and histologic reversal of BE . There was no subsquamous specialized intestinal metaplasia at the 6-month fol low-up. No complications occurred. Conclusions: Based on preliminary results, l ow-pressure spray cryoablation of BE under direct endoscopic visualization is s afe and easy to perform. Its relative lack of patient discomfort and its simplic ity and demonstrated efficacy make it a modality that should be further explored in the ablation of GI mucosal lesions such as BE and perhaps early esophageal c ancer.