Endoscopic ablation of Barrett's esophagus using argon plasma coagulation (APC) following surgical laparoscopic fundoplication.
BACKGROUND
Barrett's esopagus (BE) is considered a risk factor for the development of esophageal carcinoma. Recently, partial restoration of squamous mucosa after ablation of BE with endoscopic techniques has been described.


METHODS
From November 1996 to November 1999, 23 patients with histologically proven BE have been treated by endoscopic argon plasma coagulation (APC) following suppression of gastro-esophageal reflux by laparoscopic fundoplication. Histological follow-up after completed ablation ranged from 16 to 45 months (mean, 31.9 months).


RESULTS
Histologically, complete squamous reepithelialization was observed in 20/23 patients, whereas a regrowth of a mixed squamous and gastric type mucosa was observed in 1 patient. Small islands of intestinal metaplasia were observed under the neosquamous epithelium in two patients (9%) during follow-up.


CONCLUSIONS
The success rate of APC ablation following laparoscopic antireflux surgery in our series may be as high as 91%. Nevertheless, small islands of intestinal metaplasia under the new squamous epithelium may persist in some patients. In these circumstances, the authors recommend that endoscopic ablation of BE should be confined to controlled clinical trials.
Morino
M
M
Department of Surgery, University of Turin, Turin, Italy. mario.morino@unito.it
Rebecchi
F
F
Giaccone
C
C
Taraglio
S
S
Sidoli
L
L
Ferraris
R
R
D000328:Adult; D000368:Aged; D001128:Argon; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D001128:Argon