Long-term Follow-up After Complete Ablation With Argon Plasma Coagulation
Long-term Follow-up After Complete Ablation With Argon Plasma Coagulation
Background: Argon plasma coagulation seems to be a promising technique for ablation of Barrett's oesophagus, yet few long-term efficacy data are available.
Aim: To report on a long-term follow-up and the factors that determine the recurrence of intestinal metaplasia in a cohort of patients with non dysplastic, intestinal type Barrett's oesophagus, after complete ablation of the metaplastic mucosa with argon plasma coagulation.
Methods: Ninety-six patients underwent endoscopic argon plasma coagulation with adequate acid suppression obtained through a continuous omeprazole therapy (50 patients) or through laparoscopic fundoplication (46 patients). Complete ablation was achieved in 94 patients who underwent follow-up. Endoscopic and histological examinations were performed every 12 months.
Results: The median follow-up of the patients was 36 months (range 18-98). A recurrence of intestinal metaplasia was found in 17 patients (18%), with an annual recurrence rate of 6.1%. Neither dysplasia, nor adenocarcinoma were found during the follow-up. Through the use of logistic regression analysis, previous laparoscopic fundoplication was associated with a reduced recurrence rate of intestinal metaplasia (odds ratio 0.30, 95% confidence interval 0.10-0.93).
Conclusions: The long-term recurrence of intestinal type Barrett's oesophagus was low after complete ablation with argon plasma coagulation. The control of oesophageal acidity acid exposure with laparoscopic fundoplication seems to reduce the recurrence rate.
Oesophageal adenocarcinoma occurring on Barrett's oesophagus (BE) has become the dominant malignancy of the oesophagus and there is an increasing need to perform endoscopic therapies in order to attempt to eliminate oesophageal metaplastic mucosa.
In recent years, argon plasma coagulation (APC) has been proposed as an effective technique for the ablation of BE. The short-term effects of this technique on the restoration and maintenance of the newly formed squamous oesophageal mucosa are promising. However, few but conflicting data are available on the long-term efficacy of APC. Morris et al. reported a 30% recurrence rate in a 38.5-month follow-up study in 55 patients with BE after complete APC ablation. Kahaleh et al. reported a 62% recurrence in a group of 39 BE patients after a 36-month follow-up, suggesting that APC should not be recommended in BE ablation. On the other hand, Madisch et al. recently performed a 51-month follow-up study on 66 patients after complete ablation: they reported a 3% per year relapse rate, and identified the endoscopic detection of islands or tongues as the only positive predictor of BE recurrence.
The aims of the present study were to evaluate the long-term outcome after complete APC BE ablation, to determine which factors influence the recurrence of intestinal metaplasia and to assess the incidence of dysplasia during follow-up.
Summary and Introduction
Summary
Background: Argon plasma coagulation seems to be a promising technique for ablation of Barrett's oesophagus, yet few long-term efficacy data are available.
Aim: To report on a long-term follow-up and the factors that determine the recurrence of intestinal metaplasia in a cohort of patients with non dysplastic, intestinal type Barrett's oesophagus, after complete ablation of the metaplastic mucosa with argon plasma coagulation.
Methods: Ninety-six patients underwent endoscopic argon plasma coagulation with adequate acid suppression obtained through a continuous omeprazole therapy (50 patients) or through laparoscopic fundoplication (46 patients). Complete ablation was achieved in 94 patients who underwent follow-up. Endoscopic and histological examinations were performed every 12 months.
Results: The median follow-up of the patients was 36 months (range 18-98). A recurrence of intestinal metaplasia was found in 17 patients (18%), with an annual recurrence rate of 6.1%. Neither dysplasia, nor adenocarcinoma were found during the follow-up. Through the use of logistic regression analysis, previous laparoscopic fundoplication was associated with a reduced recurrence rate of intestinal metaplasia (odds ratio 0.30, 95% confidence interval 0.10-0.93).
Conclusions: The long-term recurrence of intestinal type Barrett's oesophagus was low after complete ablation with argon plasma coagulation. The control of oesophageal acidity acid exposure with laparoscopic fundoplication seems to reduce the recurrence rate.
Introduction
Oesophageal adenocarcinoma occurring on Barrett's oesophagus (BE) has become the dominant malignancy of the oesophagus and there is an increasing need to perform endoscopic therapies in order to attempt to eliminate oesophageal metaplastic mucosa.
In recent years, argon plasma coagulation (APC) has been proposed as an effective technique for the ablation of BE. The short-term effects of this technique on the restoration and maintenance of the newly formed squamous oesophageal mucosa are promising. However, few but conflicting data are available on the long-term efficacy of APC. Morris et al. reported a 30% recurrence rate in a 38.5-month follow-up study in 55 patients with BE after complete APC ablation. Kahaleh et al. reported a 62% recurrence in a group of 39 BE patients after a 36-month follow-up, suggesting that APC should not be recommended in BE ablation. On the other hand, Madisch et al. recently performed a 51-month follow-up study on 66 patients after complete ablation: they reported a 3% per year relapse rate, and identified the endoscopic detection of islands or tongues as the only positive predictor of BE recurrence.
The aims of the present study were to evaluate the long-term outcome after complete APC BE ablation, to determine which factors influence the recurrence of intestinal metaplasia and to assess the incidence of dysplasia during follow-up.
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