Brand B, Porthun M, von Schrenck T, Matsui U, Bohnacker S, Jäckle S, Thonke F, Seitz U, Soehendra N
Klinik für Interdisziplinäre Endoskopie, Universitätsklinik Eppendorf, Hamburg.
Zentralbl Chir. 2000;125(5):437-42.
Up to 10% of patients with Barrett's esophagus develop adenocarcinoma of the distal esophagus. Endoscopic surveillance is recommended. We studied the potential of Argon plasma coagulation (APC) for eradication of Barrett's esophagus.
Indication for APC was the histologic evidence of columnar epithelium with a length of > or = 2 cm, located proximal of the cardia and with the presence of goblet cells. Endoscopic therapy was performed using an Argonbeamer (Beamer 2, Erbe Company, Tübingen, Germany) under i.v. sedation and repeated in intervals of 2-3 weeks with the aim of complete eradication of Barrett's epithelium. One month after macroscopic Barrett eradication, superficial and deep biopsies were obtained every 2 cm in 4 quadrant technique to confirm the endoscopic aspect of complete eradication.
We report our results (follow-up median: 12 mths., 3-25) in the first 12 patients (8m/4f, median age 57 yrs., 42-69) in which treatment was completed. In one case there was evidence of moderate dysplasia. A mean of 5 (4-11) sessions were required for complete Barrett eradication in 11 patients (median size of Barrett-segment: 4 cm, range 2-11), in one patient partial regression of 50% was observed treatment was discontinued after 17 sessions while only. Deep biopsies showed subepithelial columnar epithelium islands in one case, recurrence of Barrett occurred in 2 cases after 3 and 6 months. Under APC-treatment, 11/12 patients complained about retrosternal pain and odynophagia. No other complications were observed.
Our preliminary results indicate that APC is safe and effective to eradicate Barrett's epithelium. Follow-up in a larger number of patients is necessary to assess longterm results (Barrett recurrence, decrease in the incidence of the adenocarcinoma), before APC may generally be recommended.
高达10%的巴雷特食管患者会发生食管远端腺癌。建议进行内镜监测。我们研究了氩等离子体凝固术（APC）根除巴雷特食管的潜力。
APC的指征为组织学证据显示贲门近端存在长度≥2 cm且有杯状细胞的柱状上皮。在内镜下使用氩气刀（Beamer 2，德国图宾根爱尔博公司）进行治疗，并在静脉镇静下每2 - 3周重复一次，目的是彻底根除巴雷特上皮。在肉眼可见的巴雷特上皮根除后1个月，采用四象限技术每隔2 cm进行浅表和深部活检，以确认内镜下完全根除的情况。
我们报告了前12例（8例男性/4例女性，中位年龄57岁，42 - 69岁）完成治疗患者的结果（中位随访时间：12个月，3 - 25个月）。1例有中度发育异常的证据。11例患者（巴雷特段中位大小：4 cm，范围2 - 11 cm）完全根除巴雷特上皮平均需要5次（4 - 11次）治疗，1例患者观察到50%的部分消退，仅在17次治疗后停止治疗。深部活检在1例中显示上皮下柱状上皮岛，2例在3个月和6个月后出现巴雷特复发。在APC治疗下，12例患者中有11例抱怨胸骨后疼痛和吞咽痛。未观察到其他并发症。
我们的初步结果表明，APC根除巴雷特上皮是安全有效的。在APC被普遍推荐之前，需要对更多患者进行随访以评估长期结果（巴雷特复发、腺癌发病率降低）。
