RECONSTITUTION OF SQUAMOUS EPITHELIUM IN BARRETTS-ESOPHAGUS WITH ENDOSCOPIC ARGON PLASMA COAGULATION - A PROSPECTIVE-STUDY

Background: Barrett's oesophagus is a premalignant condition. Recent r eports have suggested that laser coagulation or photodynamic therapy c ombined with acid suppression may induce reconstitution of squamous mu cosa. However, a high percentage of residual glands remain in cases tr eated with both techniques. Argon plasma coagulation (APC) appears to be an attractive alternative to other thermoablative techniques. The a im of this study was to investigate the reconstitution of squamous epi thelium in Barrett's oesophagus after APC. Methods: Fifteen patients w ith histologically proven Barrett's oesophagus were included in a pros pective study. After base-line documentation by videotaping and biopsi es, Barrett's epithelium was treated by repeated APC at intervals of 4 -6 weeks until complete squamous restoration was achieved. All patient s were kept under high-dose proton pump inhibitor therapy. Results: In 13 patients complete reconstitution of squamous epithelium was achiev ed. Buried glands after squamous restoration were detected transiently in only one case after the first session. As side effects seven patie nts had mild retrosternal discomfort. One patient reported severe retr osternal pain for 1 week. He then refused further APC sessions. Anothe r patient was excluded because of noncompliance. During the followup p eriod (6-13 months) recurrence of Barrett's epithelium was observed in one patient. Conclusions: APC is a suitable technique for achieving s quamous restoration in Barrett's oesophagus. The rare occurrence of re maining buried glands may result from the homogeneous coagulation achi eved by the ionized argon gas beam.