Argon plasma coagulation (APC) for treatment of Barrett’s oesophagus

Introduction:
Barrett’s oesophagus (BE) is a columnar metaplasia caused by chronic gastroesophageal reflux associated with increased risk of developing adenocarcinoma. There are three main goals of treatment for BE – to provide control of reflux syndrome, eradication of metaplastic tissue, and to provide a new antireflux barrier for long-term pH stabilization. Ablative therapy with argon plasma coagulation in BE patients leads to removal of metaplastic and dysplastic cells.
Aim:
To determine in a prospective study the efficacy of endoscopic argon plasma coagulation (APC) in combination with proton pump inhibitors (PPIs) for ablation of Barrett’s oesophagus with or without low grade dysplasia.
Material and methods:
Between January 2005 and December 2008, thirty patients (19 men, 11 women; mean age 54.9 years) with histologically proven BE were treated with APC in combination with 80 mg/day pantoprazole. All patients underwent endoscopy at 12 months.
Results:
After 12 months, 22 of 30 patients (73.3%) had complete regression of Barrett’s oesophagus. Regeneration of squamous epithelium was observed after a median of 1.78 sessions (range: 1 to 4). The number of sessions depends on the extent and histological type of metaplasia.
Conclusions:
Argon plasma coagulation offers a safe, minimally invasive method, which gave complete regression of metaplasia and low grade dysplasia usually in more than 70% of patients with Barrett’s oesophagus. Our results show that combination of APC and PPIs is an effective treatment option for most patients with BE.