Many modalities have been used to ablate Barrett's esophagus.
However, long term results and comparative effectiveness are unknown.
Professor Sharma and colleagues from Arizona compared the between multipolar electrocoagulation and argon plasma coagulation in Barrett's.
The research team assessed the long term efficacy of achieving complete reversal and assess factors influencing successful ablation.
Patients with Barrett's esophagus, 2 to 6 cm long, underwent 24 hour pH testing on proton pump inhibitor (PPI) therapy.
The researchers randomized patients by Barrett's esophagus length to undergo ablation with either technique every 4 to 8 weeks.
The patients received treatment until endoscopic reversal or maximal of 6 treatment sessions.
|Complete reversal of Barrett's esophagus can be maintained in 70% with both techniques|
The team followed 35 patients for at least 2 years following endoscopic ablation.
Of these, 16 were treated with multipolar electrocoagulation and 19 with argon plasma coagulation.
There was complete reversal of Barrett's esophagus in 24 patients.
Complete reversal occurred in 75% with multipolar electrocoagulation, and 63% with argon plasma coagulation.
The researchers observed no difference in the number of sessions required in the 2 groups.
There was no difference in age, pH results, Barrett's esophagus length, PPI dose, or hiatal hernia size between patients with and without complete reversal.
The team found that 1 patient developed an esophageal stricture but there were no major complications such as bleeding or perforation.
Professor Sharma's team concludes, “In Barrett's esophagus patients treated with multipolar electrocoagulation or argon plasma coagulation in combination with acid suppression, at long term follow up, complete reversal of Barrett's esophagus can be maintained in approximately 70% of patients, irrespective of the technique.”
“There are no predictors associated with achieving complete reversal of Barrett's esophagus.”
“Continued surveillance is still indicated in the post ablative setting.”
“As yet, these techniques are not ready for clinical application and cannot be offered outside the research arena.”