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PROSPECTIVE RANDOMIZED TRIAL OF ARGON PLASMA COAGULATION VERSUS MULTIPOLAR ELECTROCOAGULATION IN THE ABLATION OF BARRETT’S ESOPHAGUS WITHOUT DYSPLASIA: ONE YEAR FOLLOW-UP RESULTS
Division of Gastroenterology, Department of Medicine, St Paul’s1 and Royal Columbian2 Hospitals, University of British Columbia, Vancouver, British Columbia
Barrett’s epithelium (BE) is a premalignant condition for which regular surveillance with serial biopsies is recommended to ensure that dysplasia does not develop. Several reports have documented the use of multipolar electrocoagulation (MPEC) and argon plasma coagulation (APC) in the ablation of BE.
OBJECTIVES: In the treatment of uncomplicated BE, to compare MPEC with APC in regards to: a) Success in inducing ablation of BE as measured endoscopically and histologically b) Ease of ablation as measured by number/duration of procedures, technical difficulty, complications and cost.
METHODS: All consenting patients with confirmed, uncomplicated BE (2-8 cm) were evaluated (dysplasia excluded). Patients were randomized to APC or MPEC ablation. Procedure durations, difficulty, complications were recorded. APC was administered through the ERBE 300 generator (60W). MPEC was administered using a 10F probe (Gold Probe- Microinvasive Corp. Natick Mass) with power equivalent to 20W (ACMI BC-60 Bicap Therapeutic System; American ACMI). Endoscopic sessions were performed every 4-6 weeks until visual ablation was obtained (max. 6 sessions). All procedures were performed by one endoscopist (RE).
RESULTS: 44 patients (36 males) were consented with 39 having completed ablation protocol. (3 males excluded for >8 cm BE, one excluded with no evidence of BE). BE mean length was 4.0 cm (range 2.5-8 cm). Endoscopic ablation was successful in 19/20 patients in APC and 18/19 patients in MPEC. Histological ablation was successful in 16/20 APC patients and 14/19 MPEC patients. Mean duration of procedures (7.7 minutes), mean number of procedures (3.2) and dysphagia scores were similar between APC and MPEC groups. Technical subjective difficulty of the procedures (as judged by the endoscopist) favored APC. Of the 20 patients who have 1 year follow up, only one of them has been found to have histological evidence of BE at 1 year that was not present immediately following ablation. One patient in the MPEC developed a stricture requiring one dilation. Transient pleuritic chest pain and ‘reflux-like’ symptoms (<7d) were common.
CONCLUSIONS: BE without dysplasia can be ablated safely with both APC and MPEC. These results suggest success rates for endoscopic/histologic ablation to be over 70% and it appears to be maintained at 1 year follow up. More study is required to determine if this aggressive manner of ablating BE is necessary.