Endoscopic ablation of Barrett's esophagus using argon plasma coagulation: a prospective study after fundoplication

Pinotti, Adriana Cordeiro; Cecconello, Ivan; Sakai, Paulo; Gama-Rodrigues, Joaquim; Pinotti, H W

doi:10.1111/j.1442-2050.2004.00415.x

Cited by 29 publications

(17 citation statements)

References 18 publications

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“…There was no statistically significant difference between APC and MPEC in terms of the efficacy to achieve endoscopic and histological reversal of BE. Although the number of available randomized controlled therapeutic trials is limited, these conclusions are supported by a large amount of experimental and clinical data and with the underlying pathophysiology of BE [6][7][8][9][10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 92%

“…Several new techniques have been reported to produce successful ablation of BE, including multipolar electrocoagulation (MPEC) [6,7], argon plasma coagulation (APC) [8,9], photodynamic therapy (PDT) [10][11][12], and endoscopic mucosal resection [11,12]. The results of a number of studies suggest that these techniques are of a similar efficacy and that major side-effects are unlikely [13][14][15].…”

Section: Introductionmentioning

confidence: 97%

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A Systematic Review and Meta-Analysis of the Treatment for Barrett’s Esophagus

et al. 2008

Dig Dis Sci

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As evidence-based strategies to the clinical management of Barrett's esophagus (BE) are lacking, we have carried out a systematic review and meta-analysis of all published randomized controlled trials with the aim of evaluating the value of different approaches in the treatment of BE. Searches were conducted in the databases PUBMED, EMBASE, and Cochrane Library. Thirteen randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were assessed in more detail. Based on our search, neither the pharmacological nor surgical therapies currently available for reflux appear to achieve complete regression of BE and the elimination of the cancer risk associated with it. In contrast, endoscopic ablative techniques are capable of achieving endoscopic and histological reversal of BE, with ablation by argon plasma coagulation (APC) appearing to be more effective than treatment with photodynamic therapy (PDT) [odds ratio (OR) 3.46, 95% confidence interval (CI) 1.67-7.81, P = 0.0008]. There was no statistically significant difference between APC and multipolar electrocoagulation (MPEC) in terms of the efficacy to achieve regression of BE (OR 2.01, 95% CI 0.77-5.23, P = 0.15). In conclusion, there have been only a limited number of randomized controlled trials that compare treatments for BE. The pharmacological therapy, antireflux surgery, and endoscopic ablative techniques are promising in terms of treating BE, but the studies carried out to date have had no adequate power to assess the effect of treatment on reducing and preventing progression to adenocarcinoma.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 97%

A Systematic Review and Meta-Analysis of the Treatment for Barrett’s Esophagus

et al. 2008

Dig Dis Sci

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“…[14][15][16] Comparing APC with placebo, the ablation rate of BE was statistically significant versus the control group (63% and 15%) (P , 0.001). 17 In this work, the histopathologically documented ablation rate was 69 of 73 (94.52%) with superior initial results to the standard APC.…”

Section: Discussionmentioning

confidence: 94%

The role of argon plasma coagulation in the management of Barrett's esophagus: a single-center experience

Gad¹,

Zeid²

2011

GICTT

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Background/aim: Patients with Barrett's esophagus (BE) are 30 times more likely to develop esophageal adenocarcinoma (EAC) than the general population. Data regarding the use of argon plasma coagulation (APC) for treatment of patients with BE in Egypt are still limited. This article discusses the efficacy and safety of APC as a thermoablative modality in Egyptian patients with BE. Materials and methods: A total of 73 referred eligible patients with a confirmed endoscopic and histopathologic diagnosis of BE were enrolled in this study and subjected to thermoablation by high-power (hp)-APC equipment at a 60 W setting until complete ablation or a maximum of five sessions and were followed up clinically and endoscopically at 3-month intervals. Computergenerated randomization allocated patients into APC-treated and control groups (n = 75), all of whom were treated with a proton pump inhibitor. Results: Minor and major complications occurred in 8 of 73 (10.95%) and 1 of 73 (1.36%) patients, respectively. Macroscopic ablation was achieved after one session in 37 of 73 (50.63%) patients, and complete histologic ablation was confirmed after 167 sessions in 69 of 73 (94.52%) patients. At 1-year follow-up, no relapses of BE or progression to EAC were observed. Conclusion: hp-APC at a medium-energy setting of 60 W in an acid-reduced environment can ablate BE effectively and safely with promising initial results.

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“…Se ha demostrado que los pacientes con metaplasia de Barrett tienen de 30 a 125 veces mayor riesgo de desarrollar adenocarcinoma de esófago (1% de los pacientes) siendo el rango de aparición anual de adenocarcinoma de Barrett de 1 paciente cada 44 a 255 pacientes por año de seguimiento 9 . De allí surge la necesidad de destruir el epitelio metaplásico y regenerarlo con epitelio escamoso eliminando así el daño provocado por la presencia de reflujo ácido y/o biliar mediante tratamiento médico con inhibidores de la bomba de protones o mediante algún procedimiento quirúrgico.…”

Section: Discussionunclassified

“…Las diferencias entre las diversas técnicas probablemente se desprenden de la facilidad de aplicación, su eficacia en el logro completo de la ablación, y la estabilidad del epitelio escamoso regenerado. La mucosa neo-escamosa, regenerada post ablación de la mucosa de Barrett más el tratamiento de la ERGE con fundoplicatura, se mantiene estable durante la evaluación de seguimiento a largo plazo en dos tercios de los pacientes con erradicación inicial [8][9][10][11][12] . Los estudios prospectivos respecto de la eficacia de un enfoque multimodal, consistentes en la ablación con AP combinada con fundoplicatura laparoscópica para el tratamiento del esófago de Barrett, han mostrado que el epitelio escamoso es restaurado por completo en todos los pacientes.…”

Section: Discussionunclassified

Seguimiento Endoscópico E Histológico Post Ablación Con Argón Plasma Del Esófago De Barrett Extenso en Pacientes Sometidos a Tratamiento Quirúrgico Previo

Valladares

et al. 2014

Rev Chil Cir

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Argon plasma ablation of extensive Barrett esophagus. Experience in 19 patientsBackground: Endoscopic argon plasma ablation of Barrett esophagus decreases the risk of future esophageal cancer development. aim: To assess the endoscopic regression of columnar epithelium and the presence of intestinal metaplasia among patients operated for Barrett esophagus and subjected to argon plasma ablation. Patients and methods: In 19 patients with extensive Barrett esophagus subjected to a nissen fundoplication, Barrett esophagus was endoscopically ablated with argon plasma. Patients were assessed 6 and 12 months after surgery to evaluate the regression of columnar epithelium and the presence of intestinal metaplasia. results: One, two and three ablation sessions were carried out in 10, three and six patients, respectively. Three patients had complications. The initial length of columnar epithelium segment was 52 ± 15.6 mm and decreased to 22.6 ± 10.6 mm (p < 0.05). In 12 patients, there was absence of intestinal metaplasia on follow up, in six it persisted (one of them with "buried cells") and in one patient, dysplasia appeared. conclusions: Endoscopic argon plasma ablation may have a complementary therapeutic role for the regression of columnar epithelium in Barrett esophagus.

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Endoscopic ablation of Barrett's esophagus using argon plasma coagulation: a prospective study after fundoplication

Cited by 29 publications

References 18 publications

A Systematic Review and Meta-Analysis of the Treatment for Barrett’s Esophagus

A Systematic Review and Meta-Analysis of the Treatment for Barrett’s Esophagus

The role of argon plasma coagulation in the management of Barrett's esophagus: a single-center experience

Seguimiento Endoscópico E Histológico Post Ablación Con Argón Plasma Del Esófago De Barrett Extenso en Pacientes Sometidos a Tratamiento Quirúrgico Previo

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