Failure of Nd-YAG photocoagulation therapy as treatment for Barrett's oesophagus--a pilot study.
BACKGROUND
Acid suppression therapy and surgical antireflux procedures have not consistently led to regression of Barrett's epithelium. We reasoned that laser photocoagulation in combination with powerful acid suppression might destroy the metaplastic columnar epithelium and allow the area to be replaced by normal squamous mucosa.


METHODS
Eight patients with endoscopic and histologically proven Barrett's oesophagus were recruited into the study. Four patients were randomized to receive omeprazole 40 mg daily and four patients received the same medical therapy plus repeated laser photocoagulation administered at 4-6 weekly intervals. Endoscopies were performed on entry and at 6 months. The extent of Barrett's epithelium was assessed and mapped on to a grid system and histological changes were assessed in blinded manner by a single histopathologist. One new quadrant of Barrett's segment was irradiated per treatment.


RESULTS
Laser therapy was well tolerated and no complications occurred. After 6 months, the extent of Barrett's epithelium was unchanged in both groups. There was no appearance of squamous islands either endoscopically or microscopically in areas treated with laser.


CONCLUSIONS
Nd-YAG laser is ineffective in ablating Barrett's epithelium.
Luman
W
W
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
Lessels
A M
AM
Palmer
K R
KR
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001471:Barrett Esophagus / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010865:Pilot Projects; D017211:Treatment Failure
D000897:Anti-Ulcer Agents; D009853:Omeprazole