Argon plasma coagulation ablation versus endoscopic surveillance of Barrett’s oesophagus: late outcomes from two randomized trials.
Bright, Tim Flaxman
Game, Philip A
Devitt, Peter G
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Introduction: Argon plasma coagulation (APC) has been used to ablate dysplastic and non-dysplastic Barrett’s esophagus. In this study we determined the longer term efficacy of APC ablation within two randomized controlled trials of APC versus surveillance for Barrett’s esophagus in patients in whom gastroesophageal reflux was controlled by either surgery (Surgical trial) or proton pump inhibitors (Medical trial). Methods: One hundred and twenty nine patients with Barrett’s esophagus (nondysplastic or low grade dysplasia) were randomized to undergo either ablation using APC or ongoing endoscopy surveillance. Outcomes were determined at 3 time points: short-term (12 months), mid-term (42-75 months) and long-term (>84 months). Results: Initial ablation of >95% of the Barrett’s esophagus was achieved in 61 of 63 patients randomized to. At short-term follow-up >95% ablation persisted in 47 of 56 patients. At mid-term follow-up this continued in 33 of 49 patients. 32 were followed long term, and >95% ablation of the Barrett’s esophagus was maintained in 21 of 32. In the control groups the length of Barrett’s esophagus reduced from a mean of 4.2 cm to 3.1 cm at long term follow-up. High grade dysplasia (HGD) developed in 1 patient in the APC group and 3 in the surveillance group. Low grade dysplasia developed in 1 in the APC group and 7 in the surveillance group. Conclusions: APC ablation reduced the extent of Barrett’s esophagus, and this was maintained in some patients at longer term follow-up. However, progression to HGD can still occur despite APC ablation, suggesting endoscopic surveillance is still required.
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