PARTIAL REGRESSION OF BARRETTS-ESOPHAGUS WITH HIGH-GRADE DYSPLASIA AND ADENOCARCINOMA AFTER LASER AND HIGH-DOSE-RATE INTRALUMINAL IRRADIATION IN AN ACID ENVIRONMENT

Barrett's oesophagus is a premalignant condition. The possibility of e radicating at least partially the metaplastic epithelium has been repo rted recently. In this case report, a patient with Barrett's oesophagu s complicated by high grade dysplasia and focal adenocarcinoma was tre ated by Nd:Yag laser then high dose rate intraluminal irradiation whil e on omeprazole 40 mg/day. A partial eradication of Barrett's oesophag us and a transient tumoural regression were obtained. Histologically, residual specialized-type glandular tissue was observed beneath regene rative squamous epithelium. Four months after intraluminal irradiation , a local tumoural recurrence was detected while the area of restored squamous epithelium was unchanged on omeprazole 40 mg/day. This indica tes that physical destruction of Barrett's oesophagus associated with potent antisecretory treatment can induce a regression of the metaplas tic epithelium, even in presence of high grade dysplasia. The persista nce of specialized-type glands beneath the squamous epithelium raises important issues about its potential malignant degeneration.