Restoration of the normal squamous lining in Barrett's esophagus by argon beam plasma coagulation.
OBJECTIVE
Barrett's esophagus is associated with significantly increased risk of development of esophageal adenocarcinoma. Replacing columnar epithelium with the normal squamous lining in this condition offers the possibility of decreasing the risk of degeneration to invasive adenocarcinoma. This study aimed to establish the feasibility of argon beam plasma coagulation (ABPC), in conjunction with control of gastroesophageal reflux, to restore the squamous lining.


METHODS
Thirty patients with Barrett's esophagus (four low-grade dysplasia, three high-grade) were recruited from our surveillance program, and underwent endoscopic ABPC.


RESULTS
Twenty-seven patients completed treatment, with macroscopic replacement of their columnar lining by squamous epithelium, histologically confirmed in all 27, and followed up for a median of 9 months (range, 6-18 months). Two patterns of squamous replacement were identified: 70% of patients showed squamous epithelium with no persistent intestinal metaplasia, and in 30% the new squamous epithelium covered areas of underlying intestinal metaplasia. One patient has withdrawn from the study. Two esophageal perforations, with one death, occurred early in the study.


CONCLUSIONS
ABPC, in conjunction with control of gastroesophageal reflux, allows squamous regrowth in both benign and dysplastic Barrett's esophagus. Despite the theoretical safety advantages of ABPC over techniques such as laser, esophageal perforation may occur with this technique. It is too soon to recommend ABPC for dysplastic or nondysplastic Barrett's because follow-up is too short to show a decreased incidence of and mortality from adenocarcinoma.
Department of Oesophageal and Gastric Surgery, Hope Hospital, Manchester, England, UK.
J P
JP
Byrne
G R
GR
Armstrong
S E
SE
Attwood
D000230:Adenocarcinoma / Q000453:epidemiology; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000453:epidemiology; D004939:Esophageal Perforation / Q000209:etiology; D004947:Esophagus / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D013997:Time Factors