In several studies, argon plasma coagulation (APC), combined with acid suppression, has led to short- or medium-term eradication of Barrett's esophagus.
In this study, published in the December issue of Endoscopy, researchers sought to assess the long-term outcome following this treatment.
The research team assessed 39 patients with Barrett's esophagus, including 7 with low-grade dysplasia.
Patients underwent APC and received 40 mg omeprazole daily for eradication of the metaplastic epithelium.
|Shorter length of diseased segment and normalization of pH with PPI treatment are independent predictors of long-term re-epithelialization.|
Following the treatment period, patients were randomly assigned to receive either 20 or 40 mg omeprazole daily for long-term acid suppression.
The team evaluated histological and endoscopic changes annually.
They then used univariate and multivariate analyses were used to identify predictors of sustained reversal of Barrett's esophagus at the end of follow-up.
The median follow-up period was 36 months.
The research team determined the endoscopic and histological relapse rates at 1, 12, and 24 months, and end of follow-up. These were 30 % and 44 %, 57 % and 54 %, 60 % and 57 %, and 62 % for both, respectively.
According to multivariate analysis, shorter length of diseased segment and normalization of pH with PPI treatment were the only independent predictors of sustained long-term re-epithelialization.
The team also found that among the 7 patients with low-grade dysplasia, 4 experienced relapse after 1 month. During the long-term follow-up, 1 was lost to follow-up and all the others experienced relapse, however, only 1 developed low-grade dysplasia again.
Cancer was found in 2 cases after 12 and 18 months.
Dr Kahaleh's team concluded, "Persistence of acid reflux and greater length of diseased segment are the major factors associated with a high relapse rate after successful initial reversal".
"APC for ablation of Barrett's esophagus cannot be recommended".