WORKSHOP

IL CANCRO DELLO STOMACO

ENDOSCOPIC ARGON-PLASMA COAGULATION (APC) OF BARRETT'S ESOPHAGUS: LONG TERM FOLLOW-UP

University of Messina, Italy

L.Familiari, M.Bonica, P.Consolo, D.Fichera, P. Familiari

Messina
15 giugno 2001

Background: 
Barrett's esophagus predisposes to the development of adenocarcinoma of the esophagus and the esophago-gastric junction. The eradication of Barrett's mucosa can be achieved by many endoscopic therapies: thermo or photocoagulation, mucosectomy . Argon plasma treatment is a safe and simple method , but there are not many studies of long term follow-up. The aim of this study is the evaluation of APC and PPI treatment of the Barrett's esophagus alter a long follow-up period.

 Methods:
 20 patients (18M/2F), mean age 58.3 (29-78)yrs, with histologically demonstrated Barrett's esophagus where treated with APC and PPI. 12 cases presented short Barrett, in 5 cases the length of columnar mucosa reached 3‑4 cm, in 3 patients 5-6 cm. 12 cases presented low-grade dysplasia (all long Barrett and 4 of short). Hiatal hernia was associated in 5 cases, scarred bulb in 2, total gastrectomy in 1 and duodenal ulcer in 1. All patients were treated with APC at a power setting of 60W and 2Umin . Sessions were repeated every 3 weeks until complete eradication of Barrett and restoration of squamous mucosa. All patients received 40mg daily of Omeprazole during the treatment period and the first 6 months of follow up, 20 mg daily afterwards. In 2 patients 20mg was insufficient to let free of symptoms and was necessary 40mg daily. 1 patient was treated by laparoscopic fundoplicatio. Squamous re-epithelization was confirmed every 6 months alter APC treatment by endoscopy and the performance of 4-quadrant biopsies. 

Results: 
Complete eradication of Barrett and restoration of squamous mucosa was obtained in all patients after a mean of 1.9 sessions of APC range 1-3: six patients required only 1 session, nine required 2, and five required 3 sessions. Tolerability was good for all patients; no major complications were observed , but just mild chest-pain ìn 7 patients. After a mean follow-up of 28 months (6-36) only one case of recurrence was observed, after 6 months, with some islets of columnar mucosa: the patient was treated again with 1 session of APC. 

Conclusions: 
APC treatment of Barrett's esophagus is simple, efficacious and safe. Reversal of Barrett's mucosa can be achieved by a few endoscopic sessions. But long term follow-up studies on many patients are necessary to establish the frequency of endoscopic surveillance on the basis of recurrence or dysplasia evolution risk, in spite of APC treatment.

A cura di: Unità di Chirurgia Endoscopica - Ospedale Piemonte - Messina

© 2001