Ablation of nonneoplastic Barrett's mucosa using argon plasma coagulation with concomitant esomeprazole therapy (APBANEX): a prospective multicenter evaluation.
BACKGROUND
Complete reversal of Barrett's epithelium (BE) achieved by treatment with argon plasma coagulation (APC) is variable. The aim of this prospective study was to evaluate the effectiveness of high-power APC in a multicenter trial.


METHODS
In seven study centers, 60 patients (mean age 57, range 27-77) with nonneoplastic BE (length 1-8 cm) were recruited for treatment with high-power APC (90 W) in combination with esomeprazole 80 mg/day. Video endoscopy, chromoendoscopy, and four-quadrant biopsies (4QB) were carried out during baseline endoscopy and regular intervals. The effect of ablation was classified as complete remission (CR), partial remission, or minor response.


RESULTS
Fifty-one of the 60 patients completed ablation therapy. Three patients were lost to follow-up (FU). After a mean of 2.6 APC sessions (range 1-5) and a mean FU of 14 months (range 12-32), CR was achieved in 37 of 48 patients (77%). Major complications occurred in five of 51 patients (9.8%).


CONCLUSIONS
Complete ablation of BE can be achieved in a high percentage of patients even in a multicenter design using high-power APC. However, APC has a relevant morbidity. Therefore, ablation of nonneoplastic BE cannot be recommended generally because incidence of cancer in BE is low.
Manner
Hendrik
H
Department of Internal Medicine II, HSK Wiesbaden, Wiesbaden, Germany.
May
Andrea
A
Miehlke
Stephan
S
Dertinger
Stephan
S
Wigginghaus
Bernd
B
Schimming
Wolfgang
W
Krämer
Walter
W
Niemann
Gabriele
G
Stolte
Manfred
M
Ell
Christian
C
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001128:Argon / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D064098:Esomeprazole / Q000627:therapeutic use*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D001128:Argon; D064098:Esomeprazole