Argon plasma coagulation in the treatment of Barrett's high-grade dysplasia and in situ adenocarcinoma

Background and Study Aims: Endoscopic therapy of high-grade dysplasia (HGD) and superficial adenocarcinoma associated with Barrett's esophagus (BE), u sing Nd:YAG laser, KTP Laser, or photodynamic therapy (PDT), has been repor ted to be effective in a curative role. Argon plasma coagulation (APC) appe ars to be effective in the eradication of nondysplastic Barrett's mucosa, b ut no results are available in the management of early neoplasms complicati ng BE. We report our initial experience in the application of APC in this i ndication. Patients and Methods: Ten patients (mean age 74.2) with histologically prov en HGD (n = 7) or in situ adenocarcinoma (n = 3) associated with BE (mean l ength 6 cm) and unfit for surgery were treated using APC and high-dose omep razole (40 mg daily) until squamous re-epithelialization or complete eradic ation of the initially apparent lesions. Endoscopic follow-up was maintaine d at every 3 months. Results: Complete eradication of HGD and in situ adenocarcinoma was achieve d after a mean number of 3.3 +/- 1.5 APC sessions in 8/10 patients (80 %), The eight patients with complete clearance of the neoplastic areas did not show any evidence of local recurrence during a median follow-up of 24 month s (range 12-36 months), One patient with initial HGD had persistence of HGD 30 months after initial diagnosis, and one patient progressed to invasive adenocarcinoma after failure of APC and PDT. Conclusions: APC is safe and effective in the management of HGD and in situ adenocarcinoma associated with BE, and might represent an interesting alte rnative in selected patients who are not candidates for surgery.