Regression of intestinal metaplasia following magnetic sphincter augmentation device placement.

Autor: Alicuben ET; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Tatum JM; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Bildzukewicz N; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Samakar K; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Samaan JS; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Silverstein EN; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Sandhu K; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Houghton CC; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA., Lipham JC; Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA. john.lipham@med.usc.edu.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2019 Feb; Vol. 33 (2), pp. 576-579. Date of Electronic Publication: 2018 Jul 25.
DOI: 10.1007/s00464-018-6367-x
Abstrakt: Background: Intestinal metaplasia represents an esophageal mucosal transformation due to uncontrolled gastroesophageal reflux disease. Fundoplication has been shown to lead to regression of disease. Magnetic sphincter augmentation is an alternative to fundoplication that effectively treats reflux disease. Initially, patients with intestinal metaplasia were not considered candidates for device placement, so outcomes in these patients are unknown.
Methods: A retrospective review of all patients who underwent magnetic sphincter augmentation device placement between 2007 and 2017 was performed. All patients underwent pre-operative endoscopic evaluation and were categorized as having ultra-short segment (less than 1 cm), short-segment (1-3 cm), or long-segment (greater than or equal to 3 cm) disease. To be included in the study, pathologic examination demonstrating columnar mucosa with goblet cells was required.
Results: There were 86 patients with biopsy-proven non-dysplastic intestinal metaplasia. 35 patients had ultra-short segment, 37 patients had short-segment, and 14 patients had long-segment disease. At a median follow-up of 1.2 years, 67/86 (78%) patients completed endoscopic follow-up. 48/67 (71.6%) patients had regression of intestinal metaplasia. There was no progression to dysplasia or carcinoma. Patients with abnormal post-operative DeMeester scores were less likely to have regression of disease. Regression was more likely in the ultra-short segment (82.8%) and short-segment (73.3%) groups compared to the long-segment group (25.0%).
Conclusions: Magnetic sphincter augmentation is effective in achieving regression of intestinal metaplasia. Longer-term follow-up is needed to assess durability of effect and make meaningful comparisons to fundoplication.
Databáze: MEDLINE
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