Long-Term Follow up of Patients Submitted to Argon Plasma Coagulation of Non Dysplastic Barrett´s Esophagus after Nissen Fundoplication - Abstract
Introduction: The rising incidence of adenocarcinoma in the esophagogastric junction related to the presence of Barrett’s esophagus has established a
demand for regular endoscopic surveillance. Due to the fact that most patients do not have a complete regression of areas of intestinal metaplasia, even
with effective drug therapy and surgery, ablation techniques have been employed for the treatment of mucosal areas in Barrett’s esophagus. In 2004 Pinotti
published an evaluation of the effect of argon plasma coagulation (APC) after performing Nissen fundoplication in 19 patients with Barrett’s esophagus.
Objective: In the current study, patients were retrospectively reevaluated for the presence or absence of BE using prior endoscopic surveillance after late
follow-up.
Method: Retrospective data including the date of the patients’ last endoscopy with biopsy were retrieved. Follow-up time was established as the period
between argon plasma coagulation and the date of last endoscopy. At each endoscopic exam the presence or absence of the following data were evaluated:
columnar epithelium, intestinal metaplasia, dysplasia or adenocarcinoma.
Results: Six patients were excluded due to lack of follow-up data. The mean follow-up time was 9 years with a median of 9 years. Return of columnar
epithelium and Barrett’s esophagus was seen in 3 patients (23.1%). Ten (76.9%) of the 13 reevaluated patients showed complete regression of Barrett’s
esophagus. None of the studied patients presented dysplasia or adenocarcinoma.
Discussion: This study examined the long-term follow-up of patients undergoing ablation of Barrett’s esophagus, investigating whether ablation techniques
should be better analyzed. Recently a patient with adenocarcinoma located beneath the restored epithelium after APC was referred to our institution and
curative esophagectomy was possible. This case led us to reconsider the safety of this procedure. Considering cases of recurrence of dysplasia and progression
to intramucosal adenocarcinoma in patients who had undergone successful ablation of columnar epithelium, we are still looking for the proper way to follow
these patients.
Conclusion: In conclusion, the data suggest a lower risk in developing dysplasia and adenocarcinoma in patients who undergo ablation compared with
patients maintained only on endoscopic surveillance. Furthermore, there is not strong enough evidence that supports, even with these results, that these patients
can be excluded from frequent endoscopic surveillance or if there is a cost-effectiveness advantage in ablation therapy