High power setting argon plasma coagulation for the eradication of Barrett's esophagus

OBJECTIVE: The term Barrett's esophagus refers to a premalignant condition that is characterized by the replacement of the esophageal squamous mucosa by a columnar-lined one. Preliminary studies have demonstrated reversal of] Barrett's mucosa after endoscopic coagulation with different techniques ass ociated with acid inhibition. However, most of these studies have shown tha t residual Barrett's glands are found underneath the new squamous epitheliu m in up to 40% of patients. The goal of our study is to verify whether comp lete restoration of Barrett's mucosa can be achieved by the combination of high power setting argon plasma coagulation and omeprazole. METHODS: A total of 33 patients (mean age: 55.2 yr, range: 21-84 yr; 21 men and 12 women) with histologically demonstrated Barrett's esophagus (mean l ength: 4.05 cm, range: 0.5-7 cm) were treated. Fourteen cases presented wit h low-grade dysplasia and one with high-grade dysplasia. All of the extent, or until a maximum of 4 cm, of the Barrett's mucosa was cauterized in each session using argon beam coagulation at a power setting of 65-70 W. All pa tients received 60 mg omeprazole during the treatment period. RESULTS: Complete restoration of squamous mucosa was obtained in all 33 cas es after a mean of 1.96 sessions (range, 1-4). Endoscopic results were hist ologically confirmed. Nineteen (57.5%) patients experienced moderate to sev ere chest pain and odyno-dysphagia lasting for 3-10 days after the procedur e. Five of these cases experienced high fever and a small volume of pleural effusion, and three patients developed esophageal strictures that needed t o be dilated. Another patient developed pneumomediastinum and subcutaneous emphysema without evidences of perforation. After a mean follow-up of 10.6 months there was one endoscopic, as well as histological, recurrence of Bar rett's mucosa in a patient with an ineffective laparoscopic fundoplication. CONCLUSIONS: High power setting argon plasma coagulation combined with inte nsive acid suppression is an effective treatment for the total endoscopic a blation of Barrett's esophagus, at least in the short term. Long-term follo w-up of treated patients in whom gastroesophageal reflux is surgically or m edically alleviated seems mandatory before drawing definitive conclusions a bout this therapy. (C) 2000 by Am. Cell. of Gastroenterology.