Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation.
BACKGROUND
Patients with Barrett's oesophagus have a risk of approximately 1 per 100 patient-years for the development of oesophageal adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been shown to lead to the regrowth of a 'neo' squamous epithelium if gastro-oesophageal reflux is controlled, but the incidence of subsequent tumour formation is unknown.


METHODS
The follow-up of 55 patients who underwent endoscopic ablation of Barrett's oesophagus by argon beam plasma coagulation (ABPC) is reported. Of the 55 patients, nine had low-grade dysplasia, nine had high-grade dysplasia and the remainder had non-dysplastic Barrett's metaplasia. Twelve patients had reflux control by antireflux surgery and the remainder received proton pump inhibitor therapy. Barrett's metaplasia was ablated by ABPC to within 2 cm of the gastro-oesophageal junction.


RESULTS
To date, one patient has died and one patient was unable to complete treatment. The remaining patients were followed by regular endoscopic surveillance for a mean of 38.5 months to give a total follow-up of 173.5 patient-years. No malignancy has developed in any patient during follow-up.


CONCLUSIONS
The absence of malignant complications in this study of prophylactic ablation of long-segment Barrett's oesophagus strengthens the argument for endoscopic ablation in the prevention of oesophageal adenocarcinoma.
Morris
C D
CD
Department of Upper Gastrointestinal Surgery, Hope Hospital, Stott Lane, Salford, Manchester M6 8HD, UK.
Byrne
J P
JP
Armstrong
G R
GR
Attwood
S E
SE
D000230:Adenocarcinoma / Q000517:prevention & control*; D001128:Argon; D001471:Barrett Esophagus / Q000517:prevention & control*; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans
D001128:Argon