Treatment of Barrett's esophagus with argon plasma coagulation and antireflux surgery. A retrospective analysis

BACKGROUND/AIMS: The aim of this study was to assess the efficacy and the results of ablation of Barrett'esophagus by endoscopic argon plasma coagulation (APC) followed by fundoplication. METHODOLOGY: Between January 1999 and December 2004, 21 patients with histological proven, short BE and scheduled for fundoplication, were treated by APC. Treatment was repeated until histological confirmation of complete ablation was obtained. All patients underwent surgical correction of reflux by Nissen fundoplication. Response to treatment was assessed at follow up with endoscopy every 6 to 12 months. RESULTS: BE ablation was obtained in all patients after a mean of 3.6 APC sessions. There was no mortality and morbidity was 19% (4/21 patients). All patients underwent 360 degrees Nissen fundoplication as antireflux procedure. There was no operative mortality and no major complications requiring re-operation. Mean postoperative hospital stay was 7.9 days. Postoperatively 17/21 patients had at least one endoscopic control. The mean observation time was 17.5 months. Recurrence of Barrett epithelium was observed in 6 patients at a mean of 9.6 months after fundoplication. CONCLUSIONS: Our results show that the combination of APC and fundoplication is a safe and effective treatment option for most patients with uncomplicated BE. Although no cancer development was observed, larger studies with a longer follow up are required to assess the impact of APC on cancer risk.