Argon beam plasma coagulation as therapy for high-grade dysplasia in Barrett's esophagus.
OBJECTIVE
Patients with high-grade dysplasia in Barrett's esophagus have a high chance of developing adenocarcinoma. Previously these patients have undergone resection, however, the management of patients unsuitable for surgical resection is unclear. We have studied the long-term outcome of patients who have undergone endoscopic Argon ablation for high-grade dysplasia in Barrett's.


METHODS
Twenty-nine patients (median age, 64 yr; range, 43-85 yr) with high-grade dysplasia in Barrett's, who were unfit or had declined surgery, underwent Argon ablation and received follow-up evaluation over 7 years (mean follow-up, 37 mo; range, 7-78 mo). Treatment was stopped once there was no further histologic evidence of dysplasia. The patients then went on to receive a surveillance endoscopy at 3, 6, and 12 months after ablation, then annually thereafter.


RESULTS
High-grade dysplasia responded to treatment in 25 patients (86%); 22 of these had complete regression to neosquamous esophageal mucosa. During follow-up evaluation, no patients died of esophageal adenocarcinoma. Four patients developed cancer, 3 of whom continue with ablation therapy. The fourth patient died of unrelated causes. A single esophageal perforation was the only significant adverse event attributable to therapy. No esophageal strictures occurred and patients returned to normal activity after 24 hours in the majority of cases. Patients who received Argon ablation showed no difference in survival to that of the general population.


CONCLUSIONS
Argon beam ablation for high-grade dysplasia in Barrett's esophagus is an effective and safe treatment, especially in patients unfit for surgical resection.
Attwood
Stephen E A
SE
Department of Upper Gastro-intentinal Surgery, Hope Hospital, Stott Lane, Manchester M6 8HD, UK.
Lewis
Christopher J
CJ
Caplin
Scott
S
Hemming
Karla
K
Armstrong
Gordon
G
D000230:Adenocarcinoma / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001128:Argon / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000401:mortality / Q000628:therapy*; D001706:Biopsy; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000209:etiology / Q000401:mortality; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D017075:Laser Coagulation; D008679:Metaplasia / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous / Q000473:pathology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D001128:Argon