Abstract | OBJECTIVE: The term Barrett's esophagus refers to a premalignant condition that is characterized by the replacement of the esophageal squamous mucosa by a columnar-lined one. Preliminary studies have demonstrated reversal of Barrett's mucosa after endoscopic coagulation with different techniques associated with acid inhibition. However, most of these studies have shown that residual Barrett's glands are found underneath the new squamous epithelium in up to 40% of patients. The goal of our study is to verify whether complete restoration of Barrett's mucosa can be achieved by the combination of high power setting argon plasma coagulation and omeprazole. METHODS: A total of 33 patients (mean age: 55.2 yr, range: 21-84 yr; 21 men and 12 women) with histologically demonstrated Barrett's esophagus (mean length: 4.05 cm, range: 0.5-7 cm) were treated. Fourteen cases presented with low-grade dysplasia and one with high-grade dysplasia. All of the extent, or until a maximum of 4 cm, of the Barrett's mucosa was cauterized in each session using argon beam coagulation at a power setting of 65-70 W. All patients received 60 mg omeprazole during the treatment period. RESULTS: Complete restoration of squamous mucosa was obtained in all 33 cases after a mean of 1.96 sessions (range, 1-4). Endoscopic results were histologically confirmed. Nineteen (57.5%) patients experienced moderate to severe chest pain and odyno- dysphagia lasting for 3-10 days after the procedure. Five of these cases experienced high fever and a small volume of pleural effusion, and three patients developed esophageal strictures that needed to be dilated. Another patient developed pneumomediastinum and subcutaneous emphysema without evidences of perforation. After a mean follow-up of 10.6 months there was one endoscopic, as well as histological, recurrence of Barrett's mucosa in a patient with an ineffective laparoscopic fundoplication. CONCLUSIONS:
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Authors | J C Pereira-Lima, J V Busnello, C Saul, E B Toneloto, C V Lopes, C B Rynkowski, C Blaya |
Journal | The American journal of gastroenterology
(Am J Gastroenterol)
Vol. 95
Issue 7
Pg. 1661-8
(Jul 2000)
ISSN: 0002-9270 [Print] United States |
PMID | 10925965
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Anti-Ulcer Agents
- Argon
- Omeprazole
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anti-Ulcer Agents
(therapeutic use)
- Argon
- Barrett Esophagus
(drug therapy, pathology, surgery)
- Combined Modality Therapy
- Female
- Humans
- Laser Coagulation
(methods)
- Male
- Middle Aged
- Omeprazole
(therapeutic use)
- Postoperative Care
- Postoperative Complications
(epidemiology)
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