Biological welding – novel technique in the treatment of esophageal metaplasia

Abstract

<b>Introduction:</b> Biological welding – controlled action of high frequency current on living tissues, which leads to their structural changes and weld formation – connection with unique biological properties (strength, high elasticity, insensitivity to microbial infection, stimulating effect on the regeneration process, speed and quality which surpasses the normal uncomplicated healing) [22]. This method is used in various fields of surgery, but at the moment there is no data on its use in case of esophageal cylindrocellular (intestinal) metaplasia (further esophageal metaplasia or Barrett’s esophagus). <br><b>Objective:</b> The goal of this study is to evaluate biologic welding as a treatment option for patients with Barrett’s esophagus. <br><b>Materials and methods:</b> Single-center retrospective review of patients with short-segment Barrett’s esophagus and metaplasia were treated by argon plasma coagulation (APC) or Paton’s welding. This was followed by Nissen fundoplication. Primary outcome of this study was mucosal healing with morphological confirmation of the absence of metaplasia. The groups included patients with a short segment of the esophagus Barrett’s C2-3M3-4 (Prague Classification 2004) and high dysplasia without nodule formation in combination with hiatal hernia (VI World Congress of the International Society for Esophageal Diseases; ISED) [23–25]). <br><b>Results:</b> A total of 49 patients were included in the study with 25 patients treated by APC laser and 24 by biowelding. Four patients (16.0%) in the APC group developed stenosis and 5 patients (20.0%) developed recurrence compared to none in the biowelding group. Patients in the biowelding group had a significantly faster rate of mucosal healing leading to faster progression to Nissen fundoplication (at average 53 days) compared to APC laser group (surgery at 115 days). <br><b>Conclusions:</b> Biological welding of Paton’s is a safe and effective treatment option for patients with esophageal metaplasia.