Barrett’s oesophagus: long‐term follow‐up after complete ablation with argon plasma coagulation and the factors that determine its recurrence

Ferraris, R.; Fracchia, M.; Foti, Monica; Sidoli, L.; Taraglio, Stefano; Viganò, Luca; Giaccone, Claudio; Rebecchi, Fabrizio; Meineri, Giorgia; Senore, Carlo; Pera, A.

doi:10.1111/j.1365-2036.2007.03251.x

Cited by 41 publications

(37 citation statements)

References 25 publications

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“…Th ere is some evidence from uncontrolled observational studies to suggest that incomplete control of refl ux may be associated with increased recurrence rates following successful endotherapy ( 189,190 ). However, there is currently a lack of conclusive evidence to suggest that high-dose PPI therapy or tight control of refl ux (as determined by ambulatory pH monitoring) leads to lower recurrence rates following ablation.…”

Section: Management Of Be After Endoscopic Therapymentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Management Of Be After Endoscopic Therapymentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

View full text Add to dashboard Cite

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“…Medical therapy with maximal acid suppression has generally shown poor rates of Barrett's metaplasia regression, and an optimal protocol for surveillance is yet to be fully validated [17][18][19]. Issues with respect to these techniques have centered around incomplete ablation, especially this issue of ''buried glands'' (i.e., Barrett's metaplasia persistent under of layer of normal squamous epithelium) [8][9][10][20][21][22]. The problem is that this buried metaplasia is capable of developing into carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Toward this end, a strict protocol of twice per day proton pump inhibitors reduces the risk of Barrett's recurrence. Others also have noted that aggressively reducing acid reflux lowers the risk of Barrett's recurrence for both argon plasma coagulation and endoscopic radiofrequency ablation [21,26]. The alternative is an antireflux operation, such as a laparoscopic Nissen fundoplication.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

Velanovich

2009

Surg Endosc

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“…Many reports attribute this to the failure of proton pump inhibitor therapy to control esophageal acidity [29,30,31]. Indeed, Kahaleh et al [32] observed that following Barrett's ablation by argon plasma coagulation, pH monitoring was abnormal in 69% of patients (i.e.…”

Section: Neosquamous Epitheliummentioning

confidence: 99%

“…This occurs in two ways: (1) loss of barrier function by NSE allows greater access of luminal contents to buried Barrett's glands [11,37,38], and (2) reflux-induced injury to NSE produces inflammation whose byproducts, prostaglandins, oxy-free radicals, and cytokines, expose buried Barrett's glands to known promoters of cell turnover and malignancy [39,40,41,42,43]. In keeping with this concern is the fact that esophageal adenocarcinoma is known to occur in buried Barrett's glands [44,45,46] and buried Barrett's glands have been found in up to 44% of patients following Barrett's ablation by argon plasma coagulation [26,27,29,47]. Notably, the prevalence of buried BE following radiofrequency ablation is reported to be far lower, i.e.…”

Section: Neosquamous Epitheliummentioning

confidence: 99%

How Good Is the Neosquamous Epithelium?

Orlando¹

2014

Dig Dis

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Background/Aims: Endoscopic radiofrequency ablation of dysplastic Barrett's esophagus (BE) combined with proton pump inhibitor therapy is commonly utilized for preventing progression of dysplastic BE to esophageal adenocarcinoma. Fundamental to the success of this and all ablative approaches is the healing of the ablated areas of BE with a stratified squamous epithelium referred to as ‘neosquamous epithelium' (NSE). Although NSE appears ‘normal' endoscopically, the reemergence of BE over time in the previously ablated segments raises the question of the health and integrity of NSE. Methods: The health of NSE was recently investigated in endoscopic biopsies in vitro in a group of patients after ablation while on proton pump inhibitors. Biopsies of NSE were compared to upper squamous epithelium (USE) from the same patients morphologically (light microscopy) and with respect to barrier function by measuring electrical resistance and fluorescein flux in mini-Ussing chambers. Results: Compared to USE, NSE exhibited dilated intercellular spaces and inflammation and defective barrier function by low electrical resistance and high fluorescein flux. Moreover, NSE exhibited downregulation of claudin-4, a highly expressed protein in squamous tight junctions. Conclusion: NSE has defective barrier function in part due to downregulation of claudin-4. Since downregulation of claudin-4 increases paracellular permeability to cations, e.g. hydrogen ions, NSE is more vulnerable to attack and damage by acidic and weakly acidic refluxates - a phenomenon that may contribute in part to the reemergence of BE.

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Barrett’s oesophagus: long‐term follow‐up after complete ablation with argon plasma coagulation and the factors that determine its recurrence

Abstract: SUMMARY BackgroundArgon plasma coagulation seems to be a promising technique for ablation of Barrett's oesophagus, yet few long-term efficacy data are available.

Cited by 41 publications

References 25 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

How Good Is the Neosquamous Epithelium?

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