The American Journal of Surgery
Volume 200, Issue 2 , Pages 305-307, August 2010

Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up

Presented at the American College of Surgeons Clinical Congress, October 11–15, 2009, Chicago, IL.

  • Constantine T. Frantzides, M.D., Ph.D., F.A.C.S.

      Affiliations

    • Chicago Institute of Minimally Invasive Surgery, 4905 Old Orchard Center, Skokie, IL 60077, USA
    • Corresponding Author InformationCorresponding author. Tel.: +01-847-676-2200; fax: +01-847-676-1813
    • ,
  • Mark A. Carlson, M.D., F.A.C.S.

      Affiliations

    • Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
    • Department of Surgery, VA Medical Center, Omaha, NE, USA
    • ,
  • Ali Keshavarzian, M.D.

      Affiliations

    • Department of Gastroenterology, Rush University, Chicago, IL, USA
    • ,
  • Jacob E. Roberts, D.O.

      Affiliations

    • Chicago Institute of Minimally Invasive Surgery, 4905 Old Orchard Center, Skokie, IL 60077, USA
    • Department of Surgery, St Mary Mercy Hospital, Livonia, MI, USA

Received 21 August 2009; received in revised form 13 October 2009 published online 02 March 2010.

Abstract 

Background

The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.

Methods

Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.

Results

Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.

Conclusions

Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.

Keywords: Barrett's esophagus, High-grade esophageal dysplasia, Gastroesophageal reflux disease, Esophageal adenocarcinoma, Minimally invasive surgery, Mucosal ablation

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 The authors have no financial disclosures.

PII: S0002-9610(10)00002-4

doi:10.1016/j.amjsurg.2009.10.011

The American Journal of Surgery
Volume 200, Issue 2 , Pages 305-307, August 2010

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