Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction:a porcine model

Background: An endoscopic technique that eliminates gastroesophageal reflux disease would be of benefit to patients. The endoscopic delivery of radiof requency energy to the porcine gastroesophageal junction was investigated a nd its effect on lower esophageal sphincter pressure, gastric yield pressur e, and histology was assessed. Methods: Twenty pigs underwent esophageal manometry and endoscopic injectio n of botulinum toxin (100 units) into the lower esophageal sphincter. After 1 week, animals were randomized to radiofrequency energy treatment of the gastroesophageal junction with a 4-needle catheter and thermocouple-control led generator (n = 13) or no further intervention (control, n = 7). At 9 we eks, animals underwent esophagoscopy, manometry, gastric yield pressure det ermination, and sacrifice for histopathologic evaluation. Results: Mean lower esophageal sphincter pressure declined by 3.7 +/- 2.6 m m Hg (control, p = 0.03) vs. 0.97 +/- 5.8 mm Hg (radiofrequency, p = 0.29) after 9 weeks. Mean gastric yield pressure was 24.9 +/- 8.2 mm Hg (control) , compared with 43.4 +/- 10.7 mm Hg (radiofrequency) (p = 0.0007). Histopat hologic assessment demonstrated normal mucose, mild fibrosis, and no inflam mation. Conclusions: Radiofrequency energy delivery reversed much of the lower esop hageal sphincter pressure reduction achieved with botulinum toxin injection and augmented gastric yield pressure by 75% compared with controls. Given the safety of radiofrequency energy delivery in this study and in other are as of medicine, human studies to assess the effect of radiofrequency energy on gastroesophageal reflux disease are warranted.