Sixteen‐year follow‐up of Barrett's esophagus, endoscopically treated with argon plasma coagulation

Abstract

Objective: The thermal destruction of non-dysplastic Barrett's esophagus (BE) and its replacement by squamous epithelium is an attractive, but unproven strategy to avoid further development of dysplasia or cancer. The goal of this study was to estimate the persistence of restoration of squamous epithelium and the risk of cancer in BE that was eradicated using argon plasma coagulation (APC) in the absence of high-grade dysplasia, 16 years after its application. Design: We followed 32 patients with BE who underwent eradication of metaplastic epithelium using APC, up to 16 years later. Results: At the end of the initial treatment, 25 of 32 patients (78%) had complete endoscopic eradication, there was partial squamous re-epithelialization in four patients (13%) and it was absent in three patients (9%). We observed buried metaplastic glands under new squamous epithelium in 6 of the 25 patients who had complete endoscopic eradication. At followup, sustained complete endoscopic eradication was observed in 16 of 32 patients (50%), partial eradication in 11 of 32 patients (35%); there were two patients (6%) lost to follow-up and three patients (9%) developed esophageal adenocarcinoma. Two of the latest cases arose from the buried glands under neosquamous epithelium after complete eradication and one arose from a small remaining Barrett's segment. Conclusions: We observed long-term re-epithelialization in the majority of patients who had previously had complete eradication of Barrett's esophagus. This did not provide protection against cancer development, as the incidence of cancers arising from buried glands or from residual Barrett's esophagus was similar to that observed in patients undergoing no specific treatment.

Argon plasma coagulation for Barrett’s esophagus with low-grade dysplasia: a randomized trial with long-term follow-up on the impact of power setting and proton pump inhibitor dose

“…In total, 28 patients required a median of one additional APC to treat residual or recurrent BE. Buried metaplastic glands were detected in 10 % of patients, a rate similar or less than that reported by others [14,19,29,31,32]. The results of the present study indicate that APC of BE with LGD is oncologically safe, provided that patients for this treatment are selected carefully and treated and followed according to a strict protocol.…”

“…One patient had a severe adverse event, an esophageal perforation that required esophagectomy. The incidence of perforation and stenosis combined (4 %; 3/71) was in the lower range reported by other authors (1 %-11 %) [13,16,19,25,27,29,33]. Three out of four moderate-to-severe adverse events occurred in patients treated with high (90 W) power APC; however, the numbers were too low to evaluate association with the power setting.…”

“…The present study provides unique data on the long-term outcomes of APC treatment of BE with LGD. Other long-term observations available in the literature included exclusively or predominantly patients with nondysplastic BE [13,[17][18][19][20]. With median follow-up of 108 months, the present study offers one of the longest follow-up datasets available.…”

ESGE Survey: worldwide practice patterns amongst gastroenterologists regarding the endoscopic management of Barrett’s esophagus

“…The most commonly used techniques for eradicating non-dysplastic Barrett’s esophagus are argon plasma coagulation (APC) and radiofrequency ablation (RFA) 7 . Both techniques have been shown to be effective at eradicating Barrett’s mucosa although it is still unclear as to whether APC decreases the risk of later cancer development 13 . In our survey, there was widespread use of APC (41 % compared to only 4 % in the United States) and RFA (31 % compared to 39 % in the US survey).…”

Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects

“…Nine percent of the 50% with complete eradication at 16 years had buried glands. 55 In a direct comparison study between RFA and APC for BE mucosal ablation, outcomes at 12 months with regard to clearance of neoplasia and BE had no significant differences; however, APC was much cheaper. 56 This was a feasibility study and warrants further investigation in order to determine if APC could be considered a suitable first-line therapy.…”