title: Ablation of residual Barrett's epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs. surveillance (APE study).
abstract: OBJECTIVE
  It is commonly assumed that ablation of any remaining Barrett's epithelium after endoscopic resection of early Barrett's neoplasia improves outcome by reducing the rate of metachronous lesions, but this has not yet been evaluated in a randomized trial. The aim of this study was to compare argon plasma coagulation (APC) with surveillance only for the management of residual Barrett's epithelium following endoscopic resection.
  
  
  METHODS
  Patients in whom focal early Barrett's neoplasia (high grade intraepithelial neoplasia [HGIN] or mucosal cancer) had been curatively resected by endoscopy were randomly assigned to undergo ablation of the residual Barrett's segment by APC or surveillance only; pH-metry-adjusted proton pump inhibitor therapy was administered in both groups. The main outcome parameter was recurrence-free survival. Follow-up endoscopies with biopsies in cases of further residual Barrett's epithelium were carried out at 6-monthly intervals in both groups.
  
  
  RESULTS
  A total of 63 patients (57 male [90.5%]) were included in the study (ablation group n=33; surveillance group n=30). For complete Barrett's ablation, a mean number of 4±1.6 APC sessions were required (range 2-7). The mean follow-up duration did not differ significantly between ablation (28.2±13.7 months, range 0-44) and surveillance patients (24.7±14.8 months, range 0-45; P=0.159). The number of secondary lesions was 1 in the ablation group (3%), and 11 in the surveillance group (36.7%), leading to significantly higher recurrence-free survival for the patients undergoing ablation (P=0.005).
  
  
  CONCLUSIONS
  Thermal ablation of residual Barrett's epithelium leads to a significant reduction in neoplasia recurrence rate compared with a surveillance strategy during a limited follow-up of 2 years. A longer follow-up duration may have led to a relatively higher rate of secondary neoplasia in both groups of patients.
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Manner
authors.affiliation: Department of Internal Medicine, Diakonissen Stiftungskrankenhaus, Speyer, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rabenstein
authors.affiliation: Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Pech
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Braun
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: May
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Pohl
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Behrens
authors.affiliation: Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000188:drug therapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011159:Population Surveillance; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D057832:Watchful Waiting
chemical_list: D054328:Proton Pump Inhibitors