6947 Squamous overgrowth of barrett's metaplasia after multipolar electrocoagulation (mpec) is not a widespread phenomenon: an endoscopic ultrasound study.

Abstract

Introduction: Residual intestinal metaplasia (IM) beneath the restored squamous epithelium has been observed after MPEC treatment of Barrett's esophagus (BE). Whether this occurs as patchy/microscopic islands of IM or extensive sheets of IM that appears patchy due to inadequate biopsy sampling is unknown. Hypothesis: Extensive residual IM beneath squamous epithelium after MPEC should result in a measurable increase in esophageal wall thickness by endoscopic ultrasound (EUS). Methods: BE patients received Omeprazole 40 mg PO BID and underwent MPEC (Gold Probe, Microvasive) to a maximum 6 treatments.When no BE was seen, 4 quadrant maximum capacity biopsies were taken every 2 cm through the former BE.EUS wall thickness (mm) (Olympus GFUM20 @ 12MHz) was assessed prior to and 6 month after treatment completion from the BE segment of the esophageal wall, and as controls at the aortic arch level and the mid-body gastric wall. Data are expressed as mean±SEM. 2-tailed p-values were calculated using the paired t-test on raw data and data normalized to the gastric wall thickness (esophagus ÷ gastric thickness). Results: 25 patients (24 M) were studied. Mean BE was 3.1 cm (range 2-6). 24 achieved complete endoscopic reversal after a mean 3.5 treatment sessions (range 2-6). Biopsy-detected residual IM beneath squamous epithelium was found in 1. There was a significant decrease in esophageal wall and normalized esophageal wall thickness following MPEC (Table 1). Conclusions: MPEC of Barrett's esophagus does not cause an increase in esophageal wall thickness. Extensive residual IM beneath the restored squamous epithelium is not common.