Reversal of Barrett's esophagus with multipolar electrocoagulation: Is acid suppression important?

Kovács, Balázs; Yk, Chen; Lewis, TD; DeGuzman, Lino J.; Thompson, KS; Walter, MH; Ra, Griffin

doi:10.1016/s0016-5107(97)80192-7

Cited by 4 publications

(1 citation statement)

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“…However, the success of the procedure does not seem to depend on the complete normalisation of oesophageal acid exposure. Indeed, we observed that only one third of the treated patients have no more acid reflux under omeprazole 40 mg/day and interestingly, there was no difference between patients with persistent reflux and those without acid reflux in terms of the complete re-epithelialisation rate or complications, as recently reported 22. Nevertheless, it is probable that an optimal control of acid reflux is necessary to obtain long term maintenance of squamous re-epithelialisation.…”

Section: Discussionsupporting

confidence: 75%

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

Laethem

Cremer

Peny

et al. 1998

Gut

188

111

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Background-Intestinal metaplastic mucosa in Barrett's oesophagus can be replaced by squamous epithelium after mucosal thermal ablation associated with acid suppression therapy. Aims-To 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. Methods-Thirty 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. Results-Completere-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). Conclusions-APC combined with 40 mg omeprazole daily can eradicate Barrett's mucosa with apparent squamous reepithelialisation 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)

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Section: Discussionsupporting

confidence: 75%