ULTRASONIC EPITHELIAL ABLATION OF THE LOWER ESOPHAGUS WITHOUT STRICTURE FORMATION - A NEW TECHNIQUE FOR BARRETTS ABLATION

Background: The premalignant potential of Barrett's esophagus has stim ulated efforts to find a way to ablate the columnar epithelium in orde r to reheal the area with squamous epithelium, thus obviating the canc er risk. This study describes and evaluates a new technique using ultr asonic energy to ablate the epithelium of the lower esophagus in a por cine model. Methods: Eight young farm pigs were used to develop the te chnique of applying a laparoscopic Cavitron Ultrasonic Surgical Aspira tor (CUSA) to the lower esophageal mucosa through an operating gastros tomy. A further 11 Yakutan minipigs then underwent CUSA epithelial abl ation, followed by a laparoscopic Nissen fundoplication or postoperati ve acid suppression therapy. We then assessed the healing response in these subjects. Results: Optimal CUSA energy settings enabled complete ablation of the squamous epithelium with preservation of the muscular is mucosa and submucosa. The integrity of the aspirated cells was suff icient for cytological analysis. Healing occurred by squamous regenera tion without stricture formation. Conclusions: The CUSA technique hold s promise for complete ablation of the Barrett's epithelium in a singl e setting. The unique tissue-selective nature of the ablative process allows complete mucosal reepithelialization without stricture formatio n.