Van Laethem J L, Cremer M, Peny M O, Delhaye M, Devière J
Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
Gut. 1998 Dec;43(6):747-51. doi: 10.1136/gut.43.6.747.
Intestinal metaplastic mucosa in Barrett's oesophagus can be replaced by squamous epithelium after mucosal thermal ablation associated with acid suppression therapy.
To assess whether restoration of squamous epithelium can be obtained after ablation of Barrett's oesophagus using argon plasma coagulation (APC) associated with proton pump inhibitor (PPI) therapy.
Thirty one patients with Barrett's oesophagus received APC. Omeprazole (40 mg/day) was given from the first APC application to one month after completion of the treatment, then given symptomatically. Twenty four hour pH-metry was performed during endotherapy.
Complete re-epithelialisation was visualised at endoscopy in 25/31 patients (81%) after a mean number of 2.4 APC sessions (range 1-4). Only partial squamous re-epithelialisation was observed in three patients and three others had no eradication. At histological assessment, eradication of Barrett's oesophagus was only confirmed in 19/31 patients (61%) due to the presence of a few residual Barrett's glands under the new squamous epithelium. Complete eradication was related to a Barrett's oesophagus segment length of less than 4 cm and the absence of circumferential extension but not to the normalisation of oesophageal acid exposure under PPI therapy. Seventeen patients with apparently complete endoscopic and histological eradication of Barrett's oesophagus were re-evaluated at one year; eight (47%) disclosed relapsing islands of Barrett metaplasia despite continuous omeprazole therapy (10-40 mg/day).
APC combined with 40 mg omeprazole daily can eradicate Barrett's mucosa with apparent squamous re-epithelialisation in the majority of patients even in the absence of normalisation of oesophageal acid exposure. However, one year after endotherapy for Barrett's oesophagus, relapse is frequent but limited in extent.
在与抑酸治疗相关的黏膜热消融后，巴雷特食管的肠化生黏膜可被鳞状上皮取代。
评估使用氩等离子体凝固术（APC）联合质子泵抑制剂（PPI）治疗巴雷特食管后能否实现鳞状上皮的恢复。
31例巴雷特食管患者接受了APC治疗。从首次APC治疗开始至治疗结束后1个月给予奥美拉唑（40毫克/天），之后根据症状给药。在内镜治疗期间进行24小时pH监测。
31例患者中有25例（81%）在内镜检查时可见完全重新上皮化，平均进行了2.4次APC治疗（范围1 - 4次）。仅3例患者观察到部分鳞状重新上皮化，另外3例未根除。在组织学评估中，由于新的鳞状上皮下存在一些残留的巴雷特腺，仅19/31例患者（61%）被证实巴雷特食管已根除。完全根除与巴雷特食管段长度小于4厘米以及无环周扩展有关，但与PPI治疗下食管酸暴露的正常化无关。对17例在内镜和组织学上明显完全根除巴雷特食管的患者在1年后进行了重新评估；尽管持续使用奥美拉唑治疗（10 - 40毫克/天），仍有8例（47%）出现巴雷特化生的复发岛。
APC联合每日40毫克奥美拉唑可根除巴雷特黏膜，大多数患者可出现明显的鳞状重新上皮化，即使食管酸暴露未恢复正常。然而，巴雷特食管内镜治疗1年后，复发很常见，但范围有限。
