Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus

Columnar-lined epithelium with specialized intestinal metaplasia of the eso phagus (i.e., Barrett's esophagus) is a premalignant condition caused by ch ronic gastroesophageal reflux disease. Progression of intestinal metaplasia may be avoided by antireflux surgery, whereas regeneration of esophageal m ucosa could be achieved by endoscopic argon plasma coagulation (EAPC). The aim of this prospective study was to show the early results of a combinatio n of EAPC and antireflux surgery. Thirty patients with Barrett's esophagus were treated between August 1996 and December 1999. Regeneration of esophag eal mucosa was achieved with several sessions of EAPC under general anesthe sia. All patients were receiving a double dose of proton pump inhibitors. E ndoscopic follow-up was performed 6 to 8 weeks after the last session. Anti reflux surgery(Nissen [n = 26] or Toupet [n = 4] fundoplication) followed c omplete regeneration of the squamous epithelium in the esophagus. One year after laparoscopic fundoplication and EAPC follow-up with endoscopy and qua drant biopsies of the esophagus, 24-hour pH monitoring and esophageal manom etry were performed. All 30 patients showed complete regeneration of the sq uamous epithelium after a median of two sessions (range 1 to 7) of EAPC. Tw enty-two patients underwent 1-year follow-up studies. All showed endoscopic ally an intact fundic wrap. Recurrence of a I cm segment of Barrett's epith elium without dysplasia was present in two patients, both of whom had recur rent acid reflux due to failure of their antireflux procedure. Our results indicate that the combination of EAPC and antireflux surgery is an effectiv e treatment option in patients with Barrett's esophagus with gash oesophage al reflux disease. Long-term follow-up of this therapy is necessary to eval uate its effect on cancer risk in Barrett's esophagus.