Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation.
OBJECTIVE
To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma.


METHODS
In 70 patients with histologically proven non-neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion.


RESULTS
The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P = 0.0004).


CONCLUSIONS
The long-term relapse rate of non-neoplastic BE following complete ablation with high-power APC is low (3% per year).
Madisch
Ahmed
A
Medical Department I, Technical University Hospital, Fetscherstr. 74, D-01307 Dresden, Germany. madisch@mk1.med.tu-dresden.de
Miehlke
Stephan
S
Bayerdorffer
Ekkehard
E
Wiedemann
Birgit
B
Antos
David
D
Sievert
Anke
A
Vieth
Michael
M
Stolte
Manfred
M
Schulz
Heinrich
H
D000230:Adenocarcinoma / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001128:Argon; D001471:Barrett Esophagus / Q000453:epidemiology / Q000628:therapy*; D002278:Carcinoma in Situ / Q000453:epidemiology; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D001128:Argon