Eradication of Barrett's mucosa with argon plasma coagulation and acid suppression: immediate and mid term results

J-L Van Laethem,^a M Cremer,^a M O Peny,^b M Delhaye,^a J Devière^a

^a Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium, ^b Department of Pathology, Erasme University Hospital, Brussels, Belgium

Correspondence to: Dr J-L Van Laethem, Department of Gastroenterology, Hôpital Erasme, 808 Route de Lennik, B-1070 Brussels, Belgium.

Accepted for publication 4 June 1998

BackgroundIntestinal metaplastic mucosa in Barrett's oesophagus can be replaced by squamous epithelium after mucosal thermal ablation associated with acid suppression therapy.
AimsTo assess whether restoration of squamous epithelium can be obtained after ablation of Barrett's oesophagus using argon plasma coagulation (APC) associated with proton pump inhibitor (PPI) therapy.
MethodsThirty one patients with Barrett's oesophagus received APC. Omeprazole (40 mg/day) was given from the first APC application to one month after completion of the treatment, then given symptomatically. Twenty four hour pH-metry was performed during endotherapy.
ResultsComplete re-epithelialisation was visualised at endoscopy in 25/31 patients (81%) after a mean number of 2.4 APC sessions (range 1-4). Only partial squamous re-epithelialisation was observed in three patients and three others had no eradication. At histological assessment, eradication of Barrett's oesophagus was only confirmed in 19/31 patients (61%) due to the presence of a few residual Barrett's glands under the new squamous epithelium. Complete eradication was related to a Barrett's oesophagus segment length of less than 4 cm and the absence of circumferential extension but not to the normalisation of oesophageal acid exposure under PPI therapy. Seventeen patients with apparently complete endoscopic and histological eradication of Barrett's oesophagus were re-evaluated at one year; eight (47%) disclosed relapsing islands of Barrett metaplasia despite continuous omeprazole therapy (10-40 mg/day).
ConclusionsAPC combined with 40 mg omeprazole daily can eradicate Barrett's mucosa with apparent squamous re-epithelialisation in the majority of patients even in the absence of normalisation of oesophageal acid exposure. However, one year after endotherapy for Barrett's oesophagus, relapse is frequent but limited in extent.
(GUT 1998;43:747-751)

Keywords: Barrett's oesophagus;  argon plasma coagulation;  omeprazole;  gastro-oesophageal reflux;  Barrett's adenocarcinoma