Basu K K, Pick B, Bale R, West K P, de Caestecker J S
Department of Gastroenterology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Gut. 2002 Dec;51(6):776-80. doi: 10.1136/gut.51.6.776.
Barrett's epithelium (BE) has malignant potential. Neither acid suppression nor antireflux surgery produce consistent or complete regression of the metaplastic epithelium. Endoscopic thermoablation with argon plasma coagulation (APC) offers a different approach but factors influencing its outcome have not been systematically examined.
To assess the efficacy of APC and factors influencing initial and one year outcome.
Fifty patients, mean age 61.4 years, mean BE length 5.9 cm (range 3-19), underwent APC therapy at four weekly intervals while receiving proton pump inhibitor (PPI) therapy. BE margins were marked by India ink tattooing and extent was documented by grid drawings, photography, and 2 cm interval quadrantic jumbo biopsies. Twenty four hour ambulatory oesophageal pH studies were done while on PPIs before and after APC therapy, and Bilitec bilirubin monitoring after APC completion.
A total of 68% of patients achieved >90% BE ablation after a median of four APC sessions. Persistent BE (>10% original BE area) was associated with longer initial BE length despite more APC sessions. Persistent acid and bile reflux on PPIs, although commoner in this group, were not significantly different from those successfully ablated. Fifteen of 34 patients (44%) with successful macroscopic clearance had buried glands, present in 8.3% of a total of 338 biopsies. At the one year follow up, only 32% of those with initial successful ablation showed no recurrence. BE recurred or increased in most with mean segment length increases of 1.1 cm and 1.6 cm, respectively, in patients with previous full ablation and those with persistent BE. The presence of buried glands did not predict BE recurrence. Patients who reduced their PPI dose had significantly greater BE recurrence.
APC is most effective for shorter segment BE ablation but "buried" glands do occur. Recurrence of BE is common at one year, especially in those with initial persistent and/or long segment BE and those who reduce their PPI dose.
巴雷特食管上皮（BE）具有恶变潜能。抑酸治疗和抗反流手术均不能使化生上皮持续或完全消退。氩等离子体凝固术（APC）内镜热消融提供了一种不同的方法，但影响其疗效的因素尚未得到系统研究。
评估APC的疗效以及影响初始和一年期疗效的因素。
50例患者，平均年龄61.4岁，平均BE长度5.9 cm（范围3 - 19 cm），在接受质子泵抑制剂（PPI）治疗的同时，每隔四周接受一次APC治疗。BE边缘用印度墨水标记，范围通过网格图、摄影及每2 cm间隔的象限大活检记录。在APC治疗前后服用PPI期间进行24小时动态食管pH监测，APC完成后进行胆红素监测。
中位4次APC治疗后，共有68%的患者实现了>90%的BE消融。尽管进行了更多次APC治疗，但初始BE长度较长与持续性BE（>原始BE面积的10%）相关。服用PPI时持续存在酸和胆汁反流，虽然在该组中更常见，但与成功消融者无显著差异。34例宏观清除成功的患者中有15例（44%）存在隐窝腺，在总共338次活检中占8.3%。在一年的随访中，初始消融成功的患者中只有32%无复发。大多数患者BE复发或增多，既往完全消融患者和持续性BE患者的平均节段长度分别增加1.1 cm和1.6 cm。隐窝腺的存在不能预测BE复发。降低PPI剂量的患者BE复发明显更多。
APC对较短节段的BE消融最有效，但“隐窝”腺确实存在。BE在一年时复发很常见，尤其是初始持续性和/或长节段BE患者以及降低PPI剂量的患者。
