Randomized controlled clinical study of endoscopic radiofrequency ablation combined with medication for Barrett esophagus in Tibetan areas

doi:10.3877/ cma.j.issn.2095-8765.2020.01.005

Abstract

Abstract:

Objective

To observe the efficacy of single drug and endoscopic radiofrequency ablation (ERFA) combined with drug in the treatment of Tibetan barrette esophageal patients, and to explore a safer and more effective treatment for Tibetan barrette esophageal patients.

Methods

A total of 160 patients admitted to the department of gastroenterology of Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region from January 2017 to June 2018 were selected. Among them, 84 males and 76 females were aged from 24 to 78 years, with an average age of (50.6±12.2) years. Two groups were randomly divided into the drug treatment group and the ERFA combined treatment group using the number table method, with 80 cases in each group. The drug treatment group was treated with proton pump inhibitor and mucosal protectant for 1 month. The ERFA combined therapy group was treated with ERFA combined proton pump inhibitor and mucosal protectant. All subjects were observed with clinical symptoms, gastroscope and pathological changes before surgery, 3 months after surgery and 1 year after surgery, and the pathological types, sizes, ERFA operation time, intraoperative blood loss, postoperative length of stay, and short-term and long-term postoperative complications were recorded.

Results

There was no significant difference between the two groups in demographic information, symptoms, morphological classification and length classification (P＞0.05).Gastroscope and pathological biopsy were reviewed before, 3 months after and 1 year after the operation. The endoscopic performance and the effectiveness of pathological biopsy showed that the drug treatment group was significantly higher than the ERFA combined treatment group, and the difference was statistically significant (P＜0.05). The operation of ERFA is convenient and fast, with less intraoperative blood loss, only transient adverse reactions of different degrees during and after the operation, and no short-term and long-term serious complications.

Conclusion

The combination of ERFA and single drug therapy can effectively improve the clinical symptoms in Tibetan Barrett's esophagus patients, but the former is obviously superior to the latter in terms of endoscopy and pathological improvement. This study shows that RFA combined with proton pump inhibitor and mucosal protectant is a convenient, safe and effective method to treat Barrett's esophagus.

Key words: ERFA, Tibetan area, Barrett's esophagus, A randomized controlled clinical study

Wen Pan, Chao Liu, Tao Ren, Xiaoping Li, Weina Gao, Cuiting Liang, Qiumei Liu. Randomized controlled clinical study of endoscopic radiofrequency ablation combined with medication for Barrett esophagus in Tibetan areas[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2020, 07(01): 46-53.

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References 30

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项目	0 d	1 d	2~3 d	4~7 d
胸骨后出现烧灼感（烧心）的频率	0	1	2	3
感觉到有胃内容物（液体或食物）上返至您的喉咙或口腔（反流）的频率	0	1	2	3
感到上腹中央疼痛的频率	3	2	1	0
感到恶心的频率	3	2	1	0
因烧心和/或反流而难以获得良好夜间睡眠的频率	0	1	2	3
除医生告知服用的药物外，额外服用药物来缓解烧心和/或反流的频率（如碳酸钙、氢氧化铝）	0	1	2	3

项目	0 d	1 d	2~3 d	4~7 d
胸骨后出现烧灼感（烧心）的频率	0	1	2	3
感觉到有胃内容物（液体或食物）上返至您的喉咙或口腔（反流）的频率	0	1	2	3
感到上腹中央疼痛的频率	3	2	1	0
感到恶心的频率	3	2	1	0
因烧心和/或反流而难以获得良好夜间睡眠的频率	0	1	2	3
除医生告知服用的药物外，额外服用药物来缓解烧心和/或反流的频率（如碳酸钙、氢氧化铝）	0	1	2	3

项目		药物治疗组	ERFA联合治组	t/χ²	P
例数		80	80
	男[例(%)]	38（48%）	46（57%）	1.60	0.205
	女[例(%)]	42（52%）	34（43%）	1.60	0.205
平均年龄[岁]		58.86±7.62	50.6±12.2	12.5	0.68
症状[例(%)]
	胸痛	11（14%）	8（10%）	0.534	0.46
	胸闷	10（12%）	11（14%）	0.055	0.815
	反酸	13（16%）	14（18%）	0.45	0.83
	烧心	6（8%）	5（6%）	0.098	0.755
	咳嗽	10（12%）	5（6%）	1.84	0.175
	腹痛	5（6%）	6（8%）	0.098	0.755
	腹胀	5（6%）	8（10%）	0.198	0.548
上腹不适		8（10%）	10（12%）	0.25	0.617
	恶心	3（4%）	2（2%）	0.206	0.65
	呕吐	2（2%）	2（2%）	0.000	1.00
	嗳气	8（10%）	10（12%）	0.25	0.617
形态分型[例数(%)]
	岛型	6（7.5%）	7（8.75%）	0.084	0.77
	全周型	11（13.75%）	15（18.75%）	0.736	0.391
	舌型	63（78.75%）	58（72.5%）	0.848	0.357
长度分型[例数(%)]
	LSBE	4（5%）	2（0.25%）	0.963	0.405
	SSBE	76（95%）	78（97.5%）	0.693	0.45

项目		药物治疗组	ERFA联合治组	t/χ²	P
例数		80	80
	男[例(%)]	38（48%）	46（57%）	1.60	0.205
	女[例(%)]	42（52%）	34（43%）	1.60	0.205
平均年龄[岁]		58.86±7.62	50.6±12.2	12.5	0.68
症状[例(%)]
	胸痛	11（14%）	8（10%）	0.534	0.46
	胸闷	10（12%）	11（14%）	0.055	0.815
	反酸	13（16%）	14（18%）	0.45	0.83
	烧心	6（8%）	5（6%）	0.098	0.755
	咳嗽	10（12%）	5（6%）	1.84	0.175
	腹痛	5（6%）	6（8%）	0.098	0.755
	腹胀	5（6%）	8（10%）	0.198	0.548
上腹不适		8（10%）	10（12%）	0.25	0.617
	恶心	3（4%）	2（2%）	0.206	0.65
	呕吐	2（2%）	2（2%）	0.000	1.00
	嗳气	8（10%）	10（12%）	0.25	0.617
形态分型[例数(%)]
	岛型	6（7.5%）	7（8.75%）	0.084	0.77
	全周型	11（13.75%）	15（18.75%）	0.736	0.391
	舌型	63（78.75%）	58（72.5%）	0.848	0.357
长度分型[例数(%)]
	LSBE	4（5%）	2（0.25%）	0.963	0.405
	SSBE	76（95%）	78（97.5%）	0.693	0.45

组别	术前	术后3个月	术后1年
药物治疗组	9.34±2.04	5.40±2.33	5.03±1.52
ERFA联合治疗组	8.89±2.22	5.16±2.42	4.82±2.17
统计量/统计值（t）	1.37	0.49	1.70
P值	P=0.17	P=0.63	P=0.09

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