Efficacy and one year follow up of argon plasma coagulation therapy for ablation of Barrett's oesophagus: factors determining persistence and recurrence of Barrett's epithelium
Efficacy and one year follow up of argon plasma coagulation therapy for ablation of Barrett's oesophagus: factors determining persistence and recurrence of Barrett's epithelium
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DOI：
10.1136/gut.51.6.776
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发表时间：
2002-12-01
期刊：
影响因子：
24.5
通讯作者：
de Caestecker, JS
中科院分区：
文献类型：
--
作者：
Basu, KK;Pick, B;de Caestecker, JS
前言：巴雷特上皮(BE)具有恶性潜能。抑酸或抗反流手术都不能使化生上皮持续或完全消退。目的：评价APC的疗效及影响初始和1年疗效的因素。方法：50例患者，平均年龄61.4岁，平均BE长度5.9 cm(3~19)，在接受质子泵抑制剂(PPI)治疗的同时，每隔4周接受一次APC治疗。BE边缘用印度墨水纹身标记，范围用网格图、摄影和2厘米间隔的四边形巨型活检来记录。在APC治疗前后进行24小时动态食道pH监测，并在APC治疗结束后进行Bilitec胆红素监测。结果：在APC治疗4次的中位数后，68%的患者获得了>；90%的消融。持续BE(>；10%原始BE面积)与较长的初始BE长度相关，尽管APC会话较多。持续性胃酸和胆汁反流在PPI上虽然在这组中常见，但与那些成功消融的患者没有显著差异。肉眼清除成功的3，4名患者中有15名(44%)埋藏了腺体，占总数338例活检的8.3%。在一年的随访中，只有32%的初始消融成功的患者没有复发。复发或增加最多，平均节段长度增加分别为1.1 cm和1.6 cm，分别为既往完全消融和持续性BE。隐匿的腺体的存在并不预示复发。结论：APC对于短节段BE消融最为有效，但也存在“埋藏”腺体的现象。BE的复发在一年内很常见，特别是在那些最初持续和/或长节段BE的患者和那些减少了PPI剂量的患者。
Introduction: Barrett's epithelium (BE) has malignant potential. Neither acid suppression nor antireflux surgery produce consistent or complete regression of the metaplastic epithelium. Endoscopic thermoablation with argon plasma coagulation (APC) offers a different approach but factors influencing its outcome have not been systematically examined.Aim: To assess the efficacy of APC and factors influencing initial and one year outcome.Methods: Fifty patients, mean age 61.4 years, mean BE length 5.9 cm (range 3-19), underwent APC therapy at four weekly intervals while receiving proton pump inhibitor (PPI) therapy. BE margins were marked by India ink tattooing and extent was documented by grid drawings, photography, and 2 cm interval quadrantic jumbo biopsies. Twenty four hour ambulatory oesophageal pH studies were done while on PPIs before and after APC therapy, and Bilitec bilirubin monitoring after APC completion.Results: A total of 68% of patients achieved >90% BE ablation after a median of four APC sessions. Persistent BE (>10% original BE area) was associated with longer initial BE length despite more APC sessions. Persistent acid and bile reflux on PPIs, although commoner in this group, were not significantly different from those successfully ablated. Fifteen of 3,4 patients (44%) with successful macroscopic clearance had buried glands, present in 8.3% of a total of 338 biopsies. At the one year follow up, only 32% of those with initial successful ablation showed no recurrence. BE recurred or increased in most with mean segment length increases of 1.1 cm and 1.6 cm, respectively, in patients with previous full ablation and those with persistent BE. The presence of buried glands did not predict BE recurrence. Patients who reduced their PPI dose had significantly greater BE recurrence.Conclusions: APC is most effective for shorter segment BE ablation but "buried" glands do occur. Recurrence of BE is common at one year, especially in those with initial persistent and/or long segment BE and those who reduce their PPI dose.