Cg. Montes et al., Antireflux surgery followed by bipolar electrocoagulation in the treatmentof Barrett's esophagus, GASTROIN EN, 50(2), 1999, pp. 173-177
Background: Management of Barrett's esophagus requires reduction of gastric
acid secretion and screening for the development of adenocarcinoma. Howeve
r, the current therapeutic options are inneffective in reducing the Barrett
's mucosa. The aim of this study was to evaluate the effectiveness of endos
copic thermal coagulation of Barrett's mucosa as an alternative therapeutic
approach and the recurrence of the disease in the long term.
Methods: Fourteen patients (11 men, 3 women; mean age 45.7 years) with Barr
ett's esophagus participated in the study. They underwent laparoscopic fund
oplication and were symptom free with no defective fundoplication wraps bef
ore therapeutic endoscopy. Endoscopic thermocoagulation was performed with
a flexible videoendoscope and a bipolar probe. Mucosal areas were treated o
nce a month until the Barrett's mucosa disappeared. Endoscopy was performed
1 and 7 months after completion of the treatments and once a year thereaft
er.
Results: The mean follow-up period was 21.6 months (range 18 to 30 months).
The mean length of Barrett's esophagus was 4.8 cm. Successful ablation of
the columnar epithelium was achieved in 3.7 sessions, as defined by demonst
ration of normal squamous epithelium at histologic examination of biopsy sa
mples collected after completion of the treatments and at follow-up evaluat
ions. Three patients experienced short-term (10 days) odynophagia or dyspha
gia. All patients were symptom free with no evidence of Barrett's esophagus
at the end of the study.
Conclusions: Bipolar electrocoagulation after antireflux operations is effe
ctive in promoting regression of Barrett's esophagus and has few complicati
ons. Endoscopic thermal coagulation might reduce risk for adenocarcinoma am
ong these patients.