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Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus.

Abstract

Columnar-lined epithelium with specialized intestinal metaplasia of the esophagus (i.e., Barrett's esophagus) is a premalignant condition caused by chronic gastroesophageal reflux disease. Progression of intestinal metaplasia may be avoided by antireflux surgery, whereas regeneration of esophageal mucosa could be achieved by endoscopic argon plasma coagulation (EAPC). The aim of this prospective study was to show the early results of a combination of EAPC and antireflux surgery. Thirty patients with Barrett's esophagus were treated between August 1996 and December 1999. Regeneration of esophageal mucosa was achieved with several sessions of EAPC under general anesthesia. All patients were receiving a double dose of proton pump inhibitors. Endoscopic follow-up was performed 6 to 8 weeks after the last session. Antireflux surgery (Nissen [n = 26] or Toupet [n = 4] fundoplication) followed complete regeneration of the squamous epithelium in the esophagus. One year after laparoscopic fundoplication and EAPC follow-up with endoscopy and quadrant biopsies of the esophagus, 24-hour pH monitoring and esophageal manometry were performed. All 30 patients showed complete regeneration of the squamous epithelium after a median of two sessions (range 1 to 7) of EAPC. Twenty-two patients underwent 1-year follow-up studies. All showed endoscopically an intact fundic wrap. Recurrence of a 1 cm segment of Barrett's epithelium without dysplasia was present in two patients, both of whom had recurrent acid reflux due to failure of their antireflux procedure. Our results indicate that the combination of EAPC and antireflux surgery is an effective treatment option in patients with Barrett's esophagus with gastroesophageal reflux disease. Long-term follow-up of this therapy is necessary to evaluate its effect on cancer risk in Barrett's esophagus.

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  • Authors+Show Affiliations

    ,

    University of Wuerzburg, Germany.

    , , , , ,

    Source

    MeSH

    Adult
    Aged
    Argon
    Barrett Esophagus
    Biopsy
    Combined Modality Therapy
    Disease Progression
    Electrocoagulation
    Esophagoscopy
    Female
    Fundoplication
    Gastroesophageal Reflux
    Humans
    Laparoscopy
    Male
    Middle Aged
    Pilot Projects
    Prospective Studies
    Recurrence
    Risk Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11360048

    Citation

    Tigges, H, et al. "Combination of Endoscopic Argon Plasma Coagulation and Antireflux Surgery for Treatment of Barrett's Esophagus." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 5, no. 3, 2001, pp. 251-9.
    Tigges H, Fuchs KH, Maroske J, et al. Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus. J Gastrointest Surg. 2001;5(3):251-9.
    Tigges, H., Fuchs, K. H., Maroske, J., Fein, M., Freys, S. M., Müller, J., & Thiede, A. (2001). Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 5(3), pp. 251-9.
    Tigges H, et al. Combination of Endoscopic Argon Plasma Coagulation and Antireflux Surgery for Treatment of Barrett's Esophagus. J Gastrointest Surg. 2001;5(3):251-9. PubMed PMID: 11360048.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus. AU - Tigges,H, AU - Fuchs,K H, AU - Maroske,J, AU - Fein,M, AU - Freys,S M, AU - Müller,J, AU - Thiede,A, PY - 2001/5/22/pubmed PY - 2001/8/31/medline PY - 2001/5/22/entrez SP - 251 EP - 9 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 5 IS - 3 N2 - Columnar-lined epithelium with specialized intestinal metaplasia of the esophagus (i.e., Barrett's esophagus) is a premalignant condition caused by chronic gastroesophageal reflux disease. Progression of intestinal metaplasia may be avoided by antireflux surgery, whereas regeneration of esophageal mucosa could be achieved by endoscopic argon plasma coagulation (EAPC). The aim of this prospective study was to show the early results of a combination of EAPC and antireflux surgery. Thirty patients with Barrett's esophagus were treated between August 1996 and December 1999. Regeneration of esophageal mucosa was achieved with several sessions of EAPC under general anesthesia. All patients were receiving a double dose of proton pump inhibitors. Endoscopic follow-up was performed 6 to 8 weeks after the last session. Antireflux surgery (Nissen [n = 26] or Toupet [n = 4] fundoplication) followed complete regeneration of the squamous epithelium in the esophagus. One year after laparoscopic fundoplication and EAPC follow-up with endoscopy and quadrant biopsies of the esophagus, 24-hour pH monitoring and esophageal manometry were performed. All 30 patients showed complete regeneration of the squamous epithelium after a median of two sessions (range 1 to 7) of EAPC. Twenty-two patients underwent 1-year follow-up studies. All showed endoscopically an intact fundic wrap. Recurrence of a 1 cm segment of Barrett's epithelium without dysplasia was present in two patients, both of whom had recurrent acid reflux due to failure of their antireflux procedure. Our results indicate that the combination of EAPC and antireflux surgery is an effective treatment option in patients with Barrett's esophagus with gastroesophageal reflux disease. Long-term follow-up of this therapy is necessary to evaluate its effect on cancer risk in Barrett's esophagus. SN - 1091-255X UR - https://www.unboundmedicine.com/medline/citation/11360048/Combination_of_endoscopic_argon_plasma_coagulation_and_antireflux_surgery_for_treatment_of_Barrett's_esophagus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091255X01800457 DB - PRIME DP - Unbound Medicine ER -