Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium.
United European Gastroenterol J. 2014 Oct;2(5):367-73. doi: 10.1177/2050640614549095.
The thermal destruction of non-dysplastic Barrett's esophagus (BE) and its replacement by squamous epithelium is an attractive, but unproven strategy to avoid further development of dysplasia or cancer. The goal of this study was to estimate the persistence of restoration of squamous epithelium and the risk of cancer in BE that was eradicated using argon plasma coagulation (APC) in the absence of high-grade dysplasia, 16 years after its application.
We followed 32 patients with BE who underwent eradication of metaplastic epithelium using APC, up to 16 years later.
At the end of the initial treatment, 25 of 32 patients (78%) had complete endoscopic eradication, there was partial squamous re-epithelialization in four patients (13%) and it was absent in three patients (9%). We observed buried metaplastic glands under new squamous epithelium in 6 of the 25 patients who had complete endoscopic eradication. At follow-up, sustained complete endoscopic eradication was observed in 16 of 32 patients (50%), partial eradication in 11 of 32 patients (35%); there were two patients (6%) lost to follow-up and three patients (9%) developed esophageal adenocarcinoma. Two of the latest cases arose from the buried glands under neosquamous epithelium after complete eradication and one arose from a small remaining Barrett's segment.
We observed long-term re-epithelialization in the majority of patients who had previously had complete eradication of Barrett's esophagus. This did not provide protection against cancer development, as the incidence of cancers arising from buried glands or from residual Barrett's esophagus was similar to that observed in patients undergoing no specific treatment.
非异型增生性 Barrett 食管（BE）的热破坏及其被鳞状上皮替代是一种有吸引力但未经证实的策略，可以避免异型增生或癌症的进一步发展。本研究的目的是估计在没有高级别异型增生的情况下，使用氩等离子凝固（APC）根除 BE 后，鳞状上皮的恢复持续时间和 BE 发生癌症的风险，时间长达 16 年。
我们随访了 32 例接受 APC 根除化生上皮的 BE 患者，最长随访时间为 16 年。
在初始治疗结束时，32 例患者中有 25 例（78%）内镜下完全根除，4 例（13%）有部分鳞状上皮再上皮化，3 例（9%）无。我们在 25 例内镜下完全根除的患者中观察到 6 例有埋藏的化生腺体位于新的鳞状上皮下。在随访时，32 例患者中有 16 例（50%）持续完全内镜下根除，32 例患者中有 11 例（35%）部分根除；有 2 例（6%）失访，3 例（9%）发生食管腺癌。最新的两例病例均来自完全根除后新的鳞状上皮下埋藏的腺体，另一例来自一小段残余的 Barrett 食管。
我们观察到大多数先前完全根除 BE 的患者有长期的再上皮化。这并没有提供对癌症发展的保护，因为从埋藏腺体或残余 Barrett 食管发生的癌症的发生率与未接受特定治疗的患者相似。
