Gálvez VR, Marín SE, Funes RJF, López AG, Ramírez AF

Language: Spanish
References: 14
Page: 19-24
PDF size: 238.99 Kb.

ABSTRACT

Introduction and objective: The evolution of Barrett’s esophagus is to low (NIBG) or high grade intraepithelial neoplasia. To compare endoscopic mucosectomy versus argon ablation of Barrett’s esophagus (EB) with low grade intraepithelial neoplasia. Material and methods: In a prospective, randomized, and comparative study of 20 patients with EB and NIBG, two groups were formed; group I: ten with endoscopic mucosectomy; group II: ten with argon plasma ablation. Nissen 360^o fundoplication was performed, with three and five-year controls with biopsies. Fisher exact test was used. Results: 20 patients with mean age of 49 years and EB and NIBG, 15 males, all with GERD, with pH monitoring/24 hours less than 3.3. The histopathological results of the mucosectomy were: seven patients with EB and NIBG; one patient with in situ carcinoma and two patients with high grade intraepithelial neoplasia. In the three and five-year follow-up, nine patients in group I were endoscopically normal (p = 0.04); in group II, the follow-up at three and five years showed persistence of EB in nine cases, without dyplasia (p = 0.3). Conclusions: Endoscopic mucosectomy eliminated EB and NIBG, whereas plasma argon ablation eliminated NIBG in nine of 10 cases, with EB persisting.

REFERENCES

1. Desai TK, Krishnan K, Samala N, Singh J, Cluley J, Perla S et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012; 61 (7): 970-976.

2. Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014; 311 (12): 1209-1217.

3. Small AJ, Araujo JL, Leggett CL, Mendelson AH et al. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett’s esophagus and confirmed low-grade dysplasia. Gastroenterology. 2015; 149 (3): 567-576.

4. Luigiano C, Iabichino G, Eusebi LH, Arena M, Consolo P, Morace C et al. Outcomes of radiofrequency ablation for dysplastic Barrett’s esophagus: a comprehensive review. Gastroenterol Res Pract. 2016; 2016: 4249510.

5. Sikkema M, de Jonge PJ, Steyerberg EW, Kuipers EJ. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010; 8 (3): 235-244.

6. Shaheen NJ, Falk GW, Iyer PG, Gerson LB; American College of Gastroenterology. American College of Gastroenterology. ACG Clinical Guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016; 111 (1): 30-50.

7. Duits LC, Phoa KN, Curvers WL, Ten Kate FJ, Meijer GA, Seldenrijk CA et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert panel. Gut. 2015; 64 (5): 700-706.

8. Wani S, Rubenstein JH, Vieth M, Bergman J. Diagnosis and management of low-grade dysplasia in Barrett’s esophagus: expert review from the clinical practice updates Committee of the American Gastroenterological Association. Gastroenterology. 2016; 151 (5): 822-835.

9. Weusten B, Bisschops R, Coron E, Dinis-Ribeiro M, Dumonceau JM, Esteban JM et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017; 49 (2): 191-198.

10. Nijhawan PK, Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high grade dysplasia within Barrett’s oesophagus. Gastrointest Endosc. 2000; 52 (3): 328-332.

11. Bird-Lieberman EL, Fitzgerald RC. Barrett’s esophagus. Gastroenterol Clin North Am. 2008; 37 (4): 921-942.

12. Conio M, Ponchon T, Blanchi S, Filiberti R. Endoscopic mucosal resection. Am J Gastroenterol. 2006; 101 (3): 653-663.

13. Manner H, May A, Miehlke S, Dertinger S, Wigginghaus B, Schimming W et al. Ablation of nonneoplastic Barrett’s mucosa using argon plasma coagulation with concomitant esomeprazole therapy (APBANEX): a prospective multicenter evaluation. Am J Gastroenterol. 2006; 101 (8): 1762-1769.

14. Kahaleh M, Van Laethem JL, Nagy N, Cremer M, Devičre J. Long-term follow-up and factors predictive of recurrence in Barrett’s esophagus treated by argon plasma therapy and acid suppression. Endoscopy. 2002; 12 (12): 950-954.