Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs

Abstract

Background: Delivery of radiofrequency energy to the lower esophageal sphincter and gastric cardia is a new endoluminal technique proposed for the treatment of reflux disease. The mechanisms by which it achieves its effects are unclear. The study assessed the effect of radiofrequency energy delivery to the gastric cardia on the triggering of transient lower esophageal sphincter relaxations and gastroesophageal reflux in dogs. Methods: In 13 dogs, esophageal motility and pH were measured for 1 hour after a standard liquid meal and air infusion, as well as before and 3 months after radiofrequency energy treatment. At 7 months, histologic evaluation of the gastroesophageal junction was performed. Results: Radiofrequency energy delivery reduced the frequency of transient lower esophageal sphincter relaxations from 4.0 (3.0-6.75) (median [interquartile range]) per hour to 3.0 (2.0-3.0) per hour ( p < 0.05). This was accompanied by a significant reduction in acid reflux episodes and esophageal acid exposure. Basal lower esophageal sphincter pressure and lower esophageal sphincter relaxation during swallowing were unchanged. There was a 63% increase in wall thickness at the gastric cardia compared with that in 2 control dogs, but no gross or histopathologic abnormalities of the esophageal or gastric mucosa. Conclusion: Radiofrequency energy delivery to the gastric cardia in dogs inhibits the triggering of transient lower esophageal sphincter relaxations and thereby reduces gastroesophageal reflux. (Gastrointest Endosc 2003;57:17-22.)