[Partial regression of Barret esophagus with high grade dysplasia and adenocarcinoma after photocoagulation and endocurietherapy under antisecretory treatment].
Barrett's oesophagus is a premalignant condition. The possibility of eradicating at least partially the metaplastic epithelium has been reported recently. In this case report, a patient with Barrett's oesophagus complicated by high grade dysplasia and focal adenocarcinoma was treated by Nd:Yag laser then high dose rate intraluminal irradiation while on omeprazole 40 mg/day. A partial eradication of Barrett's oesophagus and a transient tumoural regression were obtained. Histologically, residual specialized-type glandular tissue was observed beneath regenerative squamous epithelium. Four months after intraluminal irradiation, a local tumoural recurrence was detected while the area of restored squamous epithelium was unchanged on omeprazole 40 mg/day. This indicates that physical destruction of Barrett's oesophagus associated with potent antisecretory treatment can induce a regression of the metaplastic epithelium, even in presence of high grade dysplasia. The persistence of specialized-type glands beneath the squamous epithelium raises important issues about its potential malignant degeneration.
Fremond
L
L
Service d'Hépato-Gastroentérologie, CHU Robert-Debré, Reims.
Bouché
O
O
Diébold
M D
MD
Demange
L
L
Zeitoun
P
P
Thiefin
G
G
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001471:Barrett Esophagus / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017075:Laser Coagulation; D008028:Light Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D011859:Radiography; D012074:Remission Induction
D009853:Omeprazole
Régression partielle d'un endobrachyoesophage en dysplasie de haut grade avec adénocarcinome après photocoagulation et endocuriethérapie sous traitement antisécrétoire.