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 22 January 2018

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News

Elimination of Barrett's metaplasia following endoscopic multipolar electrocoagulation therapy

Researchers from the USA have reported in Gut the first case of complete elimination of Barrett's esophagus following combination anti-reflux therapy and endoscopic thermal injury.

News image

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A 29-year-old male patient, who had received endoscopic multipolar electrocoagulation (MPEG) therapy for Barrett's esophagus, was assessed.

The researchers treated the entire surface of the metaplastic Barrett's epithelium with MPEC, until whitening of the epithelium was seen.

Barrett's esophagus can be totally eliminated by endoscopic therapy.
Gut

The patient also underwent five follow-up sessions, in which the entire residual surface of Barrett's was treated.

Following the final session, an endoscopy was performed. This revealed no apparent residual columnar mucosa in the tubular esophagus.

The subject was then placed on maintenance omeprazole (20 mg, twice daily) to control heartburn.

Following a series of complications after a fundoplication, the team performed an esophagogastrectomy on the patient.

The entire distal esophagus was submitted for histological review. No residual intestinal metaplasia was found upon intensive sectioning and search.

At the squamocolumnar junction, the columnar epithelium was free of goblet cells. The adjacent squamous epithelium was full thickness and showed minimal override of the columnar epithelium.

There was some scarring of the submucosa and the squamous epithelium was thickened, but there were no signs of intestinal metaplasia.

Dr M. B. Fennerty, of the Oregon Health Sciences University, Portland, said on behalf of colleagues, "To our knowledge, this is the first documented case of complete elimination of Barrett's esophagus following combination antireflux therapy and endoscopic thermal injury.

"This finding confirms the hypothesis that Barrett's esophagus is a reversible pre-malignant lesion, and complete elimination of Barrett's can occur within six months following therapy."

"Further data from resected and/or autopsy specimens, following endoscopic ablative therapy, are necessary to confirm the findings in this case.

"However, this report adds to a growing body of literature suggesting Barrett's esophagus can be totally eliminated, and may be curable in some patients by endoscopic therapy," it was concluded.

Gut 2001; 49: 142-4
26 June 2001

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