Barrett's epithelium (BE) has malignant potential, and neither acid suppression nor antireflux surgery produce regression of the metaplastic epithelium.
However, endoscopic thermoablation with argon plasma coagulation (APC) offers an alternate approach.
In this study, researchers from Leicester, England, assessed the efficacy of APC, and the factors influencing initial and one year outcome.
The team evaluated 50 patients whose mean age was 61 years and mean BE length was 6 cm.
Patients underwent APC therapy at four weekly intervals, while receiving proton pump inhibitor (PPI) therapy.
|68% of patients achieved >90% BE ablation after 4 APC sessions.|
The researchers marked BE margins using India ink tattooing, while extent was documented using grid drawings, photography, and 2 cm interval quadrantic jumbo biopsies.
They also performed 24 hour ambulatory esophageal pH studies while patients were on PPIs, before and after APC therapy, and performed bilirubin monitoring after APC completion.
The research team found that 68% of patients achieved greater than 90% BE ablation after a median of 4 APC sessions.
They also found persistent BE (>10% original BE area) to be associated with longer initial BE length.
Persistent acid and bile reflux on PPIs were not significantly different from those successfully ablated.
The team determined that 15 of 34 patients, with successful macroscopic clearance, had buried glands. These were present in 8% of 338 biopsies.
At the one year follow up, only 32% of those with initial successful ablation showed no recurrence.
Furthermore, BE recurred or increased in patients with previous full ablation and those with persistent BE.
However, the presence of buried glands did not predict BE recurrence.
In addition, the team found that patients who reduced their PPI dose had significantly greater BE recurrence.
Dr Basu1's team concluded, "APC is most effective for shorter segment BE ablation but "buried" glands do occur".
"Recurrence of BE is common at one year, especially in those with initial persistent and/or long segment BE and those who reduce their PPI dose".