Effective and safe endoscopic reversal of nondysplastic Barrett's esophagus with thermal electrocoagulation combined with high-dose acid inhibition: a multicenter study

Background: Barrett's esophagus is a metaplastic change in the esophageal l ining with an increased risk for adenocarcinoma. Multiple endoscopic techni ques have been applied in an effort to reverse Barrett's, This is a multice nter trial defining the efficacy and safety of multipolar electrocoagulatio n combined with high-dose acid inhibition. Methods: Patients with a 2- to 6-cm segment of Barrett's esophagus without dysplasia were enrolled at 3 centers. They were treated with omeprazole 40 mg twice daily and then with up to 6 sessions with electrocoagulation aimed at eliminating all the endoscopically apparent Barrett's, Four quadrant la rge-capacity biopsies every 2 cm were centrally assessed for residual intes tinal metaplasia. Results: Fifty-eight patients reached the endpoint of failure of visual rev ersal of Barrett's after 6 treatment sessions or a 6-month follow-up after the last session. Eighty-five percent had visual reversal and 78% both visu al and histologic reversal, Four patients had histologic evidence of residu al intestinal metaplasia. Transient esophageal symptoms were common. One pa tient developed a stricture requiring dilation and one required overnight h ospitalization for chest pain. Conclusions: The majority of patients with 2 to 6 cm of nondysplastic Barre tt's esophagus can be safely reversed with this combination therapy, Long-t erm follow-up will be necessary to document the durability of the new squam ous epithelium.