title: Diode laser treatment of Barrett's esophagus: long-term results.
abstract: Different ablation techniques have been utilized in the treatment of Barrett's esophagus (BE) to reduce the risk of degeneration. Treatment complications, risk of recurrence, and buried intestinal metaplasia (IM) are all major concerns. The effect of diode laser treatment on BE, studied in a group of patients over a long-term period, is presented here. All patients with histology of IM or low-grade dysplasia (LGD) treated with diode laser therapy for BE and followed for at least 24 months were included in the study. Treatment sessions were carried out every 3 months and bioptic follow-up examinations were done yearly. Patients without antireflux surgery received proton pump inhibitors. A total of 20 patients with IM, four of them with LGD, were treated with 161 laser sessions (in mean eight per patient) without complications. Complete, sustained endoscopic and histologic remission was obtained in 13 patients (11/12 with BE ≤ 3 cm and 2/8 with BE >3 cm, p < 0.01) and a mean of 83 ± 27% of the metaplasic tissue was removed in all the patients. All four cases of LGD healed to squamous tissue. No buried metaplasia, recurrences, or disease progressions were reported after a mean follow-up of 6 years and 2 months. Diode laser ablation is a safe and effective method in most cases of short BE, while it is less effective in the long form, requiring a large number of sessions. Long-term results show that the risk of recurrence and of buried intestinal metaplasia underneath neosquamous epithelium is negligible.
authors.affiliation: Surgical Endoscopy Unit, 1st Surgical Clinic, Surgical and Gastroenterological Sciences, Padova University, Padova, Italy. linopolese@hotmail.com
authors.forename: Lino
authors.initials: L
authors.lastname: Polese
authors.forename: Imerio
authors.initials: I
authors.lastname: Angriman
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.forename: Paola
authors.initials: P
authors.lastname: Parente
authors.forename: Francesca
authors.initials: F
authors.lastname: Erroi
authors.forename: Mauro
authors.initials: M
authors.lastname: Frego
authors.forename: Davide F
authors.initials: DF
authors.lastname: D'Amico
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Norberto
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D054023:Lasers, Semiconductor; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
references.citation: Lasers Surg Med. 2003;33(2):93-101
references.pmid: 12913880
references.citation: Scand J Gastroenterol. 2005 Jun;40(6):617-28
references.pmid: 16036520
references.citation: Gut. 2002 Dec;51(6):776-80
references.pmid: 12427775
references.citation: Am J Gastroenterol. 1999 Aug;94(8):2037-42
references.pmid: 10445525
references.citation: World J Gastroenterol. 2005 Feb 28;11(8):1182-6
references.pmid: 15754401
references.citation: Lasers Med Sci. 2006 Sep;21(3):140-6
references.pmid: 16897110
references.citation: Endoscopy. 2008 Dec;40(12):1026-32
references.pmid: 19065487
references.citation: Am J Gastroenterol. 2002 Dec;97(12):2998-3006
references.pmid: 12492182
references.citation: Dis Colon Rectum. 2005 Apr;48(4):845-50
references.pmid: 15747077
references.citation: Am J Gastroenterol. 1997 Feb;92(2):212-5
references.pmid: 9040193
references.citation: World J Surg. 2004 Apr;28(4):350-4
references.pmid: 15022019
references.citation: Endoscopy. 2008 May;40(5):388-92
references.pmid: 18459075
references.citation: Dis Esophagus. 2007;20(6):516-22
references.pmid: 17958728
references.citation: Lasers Surg Med. 2002;30(1):31-9
references.pmid: 11857601
references.citation: Am J Gastroenterol. 2003 Sep;98(9):1945-51
references.pmid: 14499770
references.citation: Aliment Pharmacol Ther. 2007 Apr 1;25(7):835-40
references.pmid: 17373922
references.citation: N Engl J Med. 2009 May 28;360(22):2277-88
references.pmid: 19474425
references.citation: Scand J Gastroenterol. 2007 Jan;42(1):23-7
references.pmid: 17190758