Impact of post RFA treatment on neosquamous epithelium microstructure

Area of Science:

• Gastroenterology
• Oncology
• Cell Biology

Background:

• Barrett's esophagus (BE) is a precancerous condition.
• Radiofrequency ablation (RFA) is an effective treatment for BE.
• Neosquamous epithelium (NSE) is the desired outcome of RFA, with reduced neoplastic potential.
• Dilated intercellular spaces (IS) are a microscopic marker of esophageal injury.

Purpose of the Study:

• To analyze the ultrastructure of NSE using transmission electron microscopy (TEM).
• To compare NSE ultrastructure based on post-RFA treatment: proton pump inhibitors (PPIs) versus laparoscopic Nissen fundoplication (LNF).
• To assess the impact of NSE ultrastructure on BE recurrence rates.

Main Methods:

• Prospective observational study involving TEM analysis of esophageal biopsies.
• Patients with complete eradication (CE) of BE at least 6 months post-RFA were included.
• Biopsies were taken from NSE and proximal esophagus.
• Intercellular space (IS) length was measured and compared between PPI and LNF groups.
• Patients were followed for 5 years with endoscopic surveillance.

Main Results:

• Twenty-two patients completed the study (12 PPI, 10 LNF).
• Mean IS length was significantly higher in the PPI group compared to the LNF group in both NSE (1.228 ± 0.226 µm vs. 0.878 ± 0.354 µm, p=0.032) and proximal esophagus (0.724 ± 0.325 µm vs. 0.378 ± 0.116 µm, p=0.009).
• BE recurrence occurred in 4 patients in the PPI group and 1 in the LNF group over 5 years (p=0.084).

Conclusions:

• Dilated intercellular spaces are prevalent in NSE of BE patients treated with PPIs post-RFA.
• Laparoscopic Nissen fundoplication may provide superior reflux protection for NSE compared to PPIs.
• LNF might reduce the recurrence rates of BE after successful RFA treatment.