Intraesophageal Polytef injection for the treatment of reflux esophagitis

Abstract

Background: In view of the unsatisfactory results of medical and surgical treatment of reflux esophagitis, a treatment modality with polytetrafluoro-ethylene injection in the lower esophagus is presented.

Methods: Twenty-one patients (13 men, 8 women; mean age 47.7 years) presented with a lower esophageal sphincter (LES) pressure which was significantly lower than normal (mean 5.3±1.1 SD cm H₂O) (P<0.001). Four to 6 ml Polytef was injected submucosally into the lower esophagus at 3 and 9 o'clock. Patients were followed up for 18–24 months.

Results: No complications were encountered. In the first 3 postinjection months, symptoms disappeared and LES pressure was elevated (mean 24.2±6.6 SD cm H₂O) (P<0.001). At the 6th month, LES pressure dropped in nine patients (P<0.05), of whom three had become symptomatic again and were reinjected. Endoscopically, esophageal hyperemia and erosion disappeared in 16 patients. At the 12th month, LES pressure was normal in 10 patients; the remaining 11 showed a significant LES pressure drop (P<0.01) with reflux manifestations and were reinjected. At the 18th month, LES pressure was normal in all patients; endoscopically, there was mild lower esophageal hyperemia in five patients. The nine patients who were followed for 24 months had normal LES pressure and endoscopic findings and were symptom-free.

Conclusions: Polytef injection achieved LES competence through elevation of LES pressure and restoration of lower esophageal rosette. Pressure drop could be due to implant egress. The technique is simple and easy, has no complications, and is performed on an outpatient basis.