Antireflux surgery followed by bipolar electrocoagulation in the treatmentof Barrett's esophagus

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.