Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett's esophagus
Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett's esophagus
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DOI：
10.1016/s0016-5107(04)02576-3
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发表时间：
2005-02-01
影响因子：
7.7
通讯作者：
Ippoliti, A
中科院分区：
文献类型：
--
作者：
Dulai, GS;Jensen, DM;Ippoliti, A
背景资料：已经描述了Barrett食管的内窥镜消融，其中各种热凝方式与高剂量的质子泵抑制剂组合使用。没有随机比较消融策略已published.Methods：转诊患者进行筛选，以确定那些与巴雷特食管2至7厘米的长度，没有高度异型增生或癌症。纳入的患者接受泮托拉唑（40 mg，每日两次），随后随机接受氩等离子体凝固（APC）或多极电凝（MPEC）治疗。T e的主要结果测量的治疗会话所需的内镜ablation.Results：235例筛选，52例随机。MPEC组Barrett食管的平均长度为3.1 cm，APC组为4.0 cm（p = 0.03）。除此之外，治疗组的基线特征相似。在意向治疗分析中，MPEC和APC（p = 0.04）的内镜消融所需的平均治疗次数分别为2.9和3.8（p = 0.249，校正Barrett食管长度差异后）。MPEC组和APC组在内镜下胃食管交界处近端实现消融的患者比例分别为88%和81%（p = 0.68），MPEC组和APC组在组织学上分别为81%和65%（p = 0.21）。MPEC首次治疗所需的平均时间为6分钟，APC为10分钟（p = 0.01）。符合方案分析。无严重不良事件，但MPEC后8%与APC后13%出现一过性中度至重度上消化道症状（p = 0.64）。虽然没有统计学显著差异，但使用泮托拉唑和MPEC消融Barrett食管所需的治疗次数在数值上更少，与泮托拉唑和APC治疗相比，在更大比例的患者中实现了内镜和组织学消融。
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.