Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett's esophagus

被引:90
作者
Dulai, GS [1 ]
Jensen, DM [1 ]
Cortina, G [1 ]
Fontana, L [1 ]
Ippoliti, A [1 ]
机构
[1] Univ Calif Los Angeles, Sch Med,Ctr Study Digest Healthcare Qual & Outcom, CURE Digest Dis Res Ctr, VA Greater Los Angeles Healthcare Syst, Los Angeles, CA 90073 USA
关键词
D O I
10.1016/S0016-5107(04)02576-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Endoscopic ablation of Barrett's esophagus has been described in which various thermocoagulation modalities are used in combination with a high dose of a proton pump inhibitor. No randomized comparison of ablation strategies has been published. Methods: Referred patients were screened to identify those with Barrett's esophagus 2 to 7 cm in length, without high-grade dysplasia or cancer. Included patients received pantoprazole (40 mg twice a day), followed by randomization to treatment with argon plasma coagulation (APC) or multipolar electrocoagulation (MPEC). T e primary outcome measure was the number of treatment sessions required for endoscopic ablation. Results: Of 235 patients screened, 52 were randomized. The mean length of Barrett's esophagus was 3.1 cm in the MPEC group vs. 4.0 cm in the APC group (p = 0.03). Otherwise, the treatment groups were similar with regard to baseline characteristics. The mean number of treatment sessions required for endoscopic ablation was 2.9 for MPEC vs. 3.8 for APC (p = 0.04) in an intention-to-treat analysis (p = 0.249, after adjustment for the difference in length of Barrett's esophagus). The proportion of patients in which ablation was endoscopically achieved proximal to the gastroesophageal junction was 88% for the MPEC group vs. 81% for the APC group (p = 0.68) and histologically achieved in 81% for MPEC vs. 65% for APC (p = 0.21). The mean time required for the first treatment session was 6 minutes with MPEC vs. 10 minutes with APC (p = 0.01.) in per protocol analysis. There was no serious adverse event, but transient moderate to severe upper-GI symptoms occurred after MPEC in 8% vs. 13% after APC (p = 0.64). Conclusions: Although there were no statistically significant differences, ablation of Barrett's esophagus with pantoprazole and MPEC required numerically fewer treatment sessions, and endoscopic and histologic ablation was achieved in a greater proportion of patients compared with treatment with pantoprazole and APC.
引用
收藏
页码:232 / 240
页数:9
相关论文
共 29 条
[11]   HEALING AND RELAPSE OF SEVERE PEPTIC ESOPHAGITIS AFTER TREATMENT WITH OMEPRAZOLE [J].
HETZEL, DJ ;
DENT, J ;
REED, WD ;
NARIELVALA, FM ;
MACKINNON, M ;
MCCARTHY, JH ;
MITCHELL, B ;
BEVERIDGE, BR ;
LAURENCE, BH ;
GIBSON, GG ;
GRANT, AK ;
SHEARMAN, DJC ;
WHITEHEAD, R ;
BUCKLE, PJ .
GASTROENTEROLOGY, 1988, 95 (04) :903-912
[12]   Long-term follow-up and factors predictive of recurrence in Barrett's esophagus treated by argon plasma coagulation and acid suppression [J].
Kahaleh, M ;
Van Laethem, JL ;
Nagy, N ;
Cremer, M ;
Devière, J .
ENDOSCOPY, 2002, 34 (12) :950-955
[13]   Successful reversal of Barrett's esophagus with multipolar electrocoagulation despite inadequate acid suppression [J].
Kovacs, BJ ;
Chen, YK ;
Lewis, TD ;
DeGuzman, LJ ;
Thompson, KS .
GASTROINTESTINAL ENDOSCOPY, 1999, 49 (05) :547-553
[14]   Inflammation of the gastro-oesophageal junction (carditis) in patients with symptomatic gastro-oesophageal reflux disease: a prospective study [J].
Lembo, T ;
Ippoliti, AF ;
Ramers, C ;
Weinstein, WM .
GUT, 1999, 45 (04) :484-488
[15]   AN ENDOSCOPIC BIOPSY PROTOCOL CAN DIFFERENTIATE HIGH-GRADE DYSPLASIA FROM EARLY ADENOCARCINOMA IN BARRETTS-ESOPHAGUS [J].
LEVINE, DS ;
HAGGITT, RC ;
BLOUNT, PL ;
RABINOVITCH, PS ;
RUSCH, VW ;
REID, BJ .
GASTROENTEROLOGY, 1993, 105 (01) :40-50
[16]  
Maass S, 1998, Z GASTROENTEROL, V36, P301
[17]   Antireflux surgery followed by bipolar electrocoagulation in the treatment of Barrett's esophagus [J].
Montes, CG ;
Brandalise, NA ;
Deliza, R ;
de Magalhaes, AFN ;
Ferraz, JGP .
GASTROINTESTINAL ENDOSCOPY, 1999, 50 (02) :173-177
[18]   Endoscopic ablation of Barrett's esophagus using argon plasma coagulation (APC) following surgical laparoscopic fundoplication [J].
Morino, M ;
Rebecchi, F ;
Giaccone, C ;
Taraglio, S ;
Sidoli, L ;
Ferraris, R .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2003, 17 (04) :539-542
[19]  
Mörk H, 1998, SCAND J GASTROENTERO, V33, P1130
[20]   Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation [J].
Morris, CD ;
Byrne, JP ;
Armstrong, GRA ;
Attwood, SEA .
BRITISH JOURNAL OF SURGERY, 2001, 88 (10) :1357-1362