PMID- 16905695
OWN - NLM
STAT- MEDLINE
DCOM- 20060921
LR  - 20181113
IS  - 0017-5749 (Print)
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 55
IP  - 9
DP  - 2006 Sep
TI  - A randomised controlled trial of ablation of Barrett's oesophagus with multipolar 
      electrocoagulation versus argon plasma coagulation in combination with acid 
      suppression: long term results.
PG  - 1233-9
AB  - BACKGROUND: Many modalities have been used to ablate Barrett's oesophagus (BO). 
      However, long term results and comparative effectiveness are unknown. AIMS: Our 
      aim was to compare the long term efficacy of achieving complete reversal 
      (endoscopic and histological) between multipolar electrocoagulation (MPEC) and 
      argon plasma coagulation (APC) in BO patients and assess factors influencing 
      successful ablation. METHODS: Patients with BO, 2-6 cm long, underwent 24 hour pH 
      testing on proton pump inhibitor (PPI) therapy. Patients were then randomised by 
      BO length to undergo ablation with MPEC or APC every 4-8 weeks until endoscopic 
      reversal or maximal of six treatment sessions. RESULTS: Thirty five BO patients 
      have been followed for at least two years following endoscopic ablation, 16 
      treated with MPEC and 19 with APC. There was complete reversal of BO in 24 
      patients (69%); 75% with MPEC and 63% with APC (p = 0.49). There was no 
      difference in the number of sessions required in the two groups. There was no 
      difference in age, pH results, BO length, PPI dose, or hiatal hernia size between 
      patients with and without complete reversal. One patient developed an oesophageal 
      stricture but there were no major complications such as bleeding or perforation. 
      CONCLUSIONS: In BO patients treated with MPEC or APC in combination with acid 
      suppression, at long term follow up, complete reversal of BO can be maintained in 
      approximately 70% of patients, irrespective of the technique. There are no 
      predictors associated with achieving complete reversal of BO. Continued 
      surveillance is still indicated in the post ablative setting. As yet, these 
      techniques are not ready for clinical application (other than for high grade 
      dysplasia or early oesophageal adenocarcinoma) and cannot be offered outside the 
      research arena.
FAU - Sharma, P
AU  - Sharma P
AD  - University of Kansas School of Medicine and Veterans Affairs Medical Center, 
      Kansas City, MO 64128-2295, USA. psharma@kumc.edu
FAU - Wani, S
AU  - Wani S
FAU - Weston, A P
AU  - Weston AP
FAU - Bansal, A
AU  - Bansal A
FAU - Hall, M
AU  - Hall M
FAU - Mathur, S
AU  - Mathur S
FAU - Prasad, A
AU  - Prasad A
FAU - Sampliner, R E
AU  - Sampliner RE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 0 (Antacids)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Gut. 2006 Sep;55(9):1222-3. PMID: 16905690
CIN - Gut. 2007 Jun;56(6):884-5; author reply 885. PMID: 17519491
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antacids/therapeutic use
MH  - Barrett Esophagus/drug therapy/pathology/*surgery
MH  - Combined Modality Therapy
MH  - Electrocoagulation/adverse effects/*methods
MH  - Esophageal Neoplasms/drug therapy/pathology/*surgery
MH  - Esophagoscopy/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Laser Coagulation/adverse effects/*methods
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic
MH  - Precancerous Conditions/drug therapy/pathology/*surgery
MH  - Prognosis
MH  - Proton Pump Inhibitors
MH  - Treatment Outcome
PMC - PMC1860010
COIS- Conflict of interest: None declared.
EDAT- 2006/08/15 09:00
MHDA- 2006/09/22 09:00
PMCR- 2009/09/01
CRDT- 2006/08/15 09:00
PHST- 2006/08/15 09:00 [pubmed]
PHST- 2006/09/22 09:00 [medline]
PHST- 2006/08/15 09:00 [entrez]
PHST- 2009/09/01 00:00 [pmc-release]
AID - 55/9/1233 [pii]
AID - gt86777 [pii]
AID - 10.1136/gut.2005.086777 [doi]
PST - ppublish
SO  - Gut. 2006 Sep;55(9):1233-9. doi: 10.1136/gut.2005.086777.