The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus,☆☆

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 17-20, 1998, New Orleans, Louisiana.
https://doi.org/10.1016/S0016-5107(99)70338-XGet rights and content

Abstract

Background: Thermoablation is being used to eliminate the metaplastic epithelium of Barrett's esophagus and allow its reversal into squamous epithelium in an acid-controlled environment. This study assessed the efficacy and safety of a new thermoablation technique, argon plasma coagulation. Methods: Patients with circumferential Barrett's esophagus 2 to 5 cm long were enrolled. Acid suppression was accomplished with lansoprazole. One-half the circumference of Barrett's mucosa was treated with argon plasma coagulation, and the other half served as an internal control. After macroscopic squamous re-epithelialization occurred, biopsy specimens were obtained from both areas systematically. Results: Nine patients, all men with a mean age of 51.1 years, completed the study. During 24-hour esophageal pH monitoring a pH less than 4 occurred on average 2.8% of the time with a mean dose of lansoprazole of 70 mg/day. Squamous re-epithelialization developed in treated areas in all 9 patients. Biopsy showed that 7 of 9 patients (77.8%) had squamous re-epithelialization without intestinal metaplasia. Biopsy showed that 2 of 9 patients (22.2%) had squamous re-epithelialization with evidence of underlying intestinal metaplasia. There were no serious complications. Conclusions: Argon plasma coagulation in an acid-controlled environment was both efficacious and safe in the treatment of Barrett's esophagus. However, the reappearance of squamous epithelium after therapy did not exclude the presence of underlying intestinal metaplasia. (Gastrointest Endosc 1999;50:18-22.)

Section snippets

PATIENTS AND METHODS

Patients with circumferential Barrett's esophagus (columnar mucosa found at endoscopy and specialized intestinal metaplasia on biopsy) 2 to 5 cm long were prospectively recruited for the study. Patients were excluded if they had evidence of dysplasia on biopsy, known cardiac disease, or lung disease requiring supplemental oxygen or any other contraindication to repeated endoscopy and extensive mucosal sampling. Each patient gave informed consent as approved by the human subjects committee of

RESULTS

Ten patients, all men, with Barrett's esophagus were included. Nine patients completed the study. The mean age was 51.1 ± 1.9 years. The mean length of Barrett's esophagus was 3.6 ± 0.4 cm. The patient who discontinued the study did so because of discomfort during the initial treatment session.

Eight of the 9 patients who completed the study underwent 24-hour ambulatory pH monitoring. One patient could not tolerate passage of the probe. Four patients underwent 24-hour pH studies before APC

DISCUSSION

The incidence of adenocarcinoma among persons with Barrett's esophagus is estimated to be 30 to 40 times that of the healthy population.1, 24, 25, 26 The largest prospective evaluation reported to date found an incidence of adenocarcinoma equaling 1 per 208 patient-years of follow-up study.27 The intestinal metaplasia of Barrett's esophagus is thought to arise from abnormal cell differentiation after injury caused by acid reflux. The current working hypothesis is that putative esophageal stem

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    Reprint requests: Francisco C. Ramirez, MD, Chief, Gastroenterology, Carl T. Hayden VA Medical Center, 650 E. Indian School Rd., Phoenix, AZ 85012.

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