TREATMENT OF BARRETTS-ESOPHAGUS BY ENDOSCOPIC LASER-ABLATION AND ANTIREFLUX SURGERY

Objective The regeneration of intestinal metaplasia by squamous epithe lium in 17 patients with Barrett's esophagus after endoscopic laser ab lation in a reflux-free environment after successful antireflux surger y was prospectively examined. Methods All patients had antireflux surg ery, and healing of reflux was verified at postoperative endoscopy and 24-hour esophageal pH monitoring. Thereafter, in 11 patients, the who le Barrett's epithelium was ablated using endoscopic Nd-YAG laser ener gy in 1 to 8 sessions (mean, 4). The needed energy was 965 to 11,173 j oules (mean 4709), or about 1000 joules per centimeter of Barrett's es ophagus. Six patients had no laser ablation but were treated by antire flux surgery and served as a control group. Results In all laser-treat ed patients, the regenerated epithelium was histologically of squamous type in the tubular esophagus, but two patients still had intestinal metaplasia in the gastric cardia. In controls, the length of Barrett's esophagus and intestinal metaplasia remained unchanged. The length of follow-up was 26 months after the last laser session and 21 months in the control group. Conclusions The regenerated esophageal epithelium arising after laser ablation in reflux-free environment surgery is of squamous type. This treatment may have a role in preventing the develo pment of esophageal adenocarcinoma arising in Barrett's esophagus.