Laser and multipolar electrocoagulation ablation of early Barrett's adenocarcinoma: long-term follow-up

Abstract

Background: Endoscopic ablation of Barrett's esophagus, including associated dysplasia and adenocarcinoma, can be achieved by various techniques, but few long-term results are available. The aim of our study was ablation of intramucosal adenocarcinoma with a combination of Nd:YAG laser plus multipolar electrocoagulation. Methods: Patients with documented Barrett's esophagus and adenocarcinoma who either had refused surgery or were poor candidates for surgery because of high risk were offered endoscopic therapy. Patients underwent therapy with Nd:YAG laser and multipolar electrocoagulation. They were treated with omeprazole (20 mg twice daily) as maintenance therapy. Results: Six patients were enrolled in the study over a 7-year period. All were men with a mean age of 78.2 years. The mean length of Barrett's esophagus was 6.0 cm (range, 3 to 10 cm). Seventeen Nd:YAG laser (mean, 2.8/patient) and 20 multipolar electrocoagulation (mean, 3.3/patient) sessions were used during the study period. All patients had a complete initial response to therapy. One patient on chronic immunosuppressive medications had recurrence of the tumor after an initial complete response (36-month follow-up). Two patients have no evidence of Barrett's esophagus, and 3 patients have residual intestinal metaplasia on biopsy of an irregular appearing “neo” Z-line. Mean follow-up in this group is 3.4 years (range, 9 to 86 months). Conclusions: Laser photocoagulation and multipolar electrocoagulation can be successfully and safely used to ablate intramucosal adenocarcinoma in the setting of Barrett's esophagus. Patients remain functional with normal swallowing. (Gastrointest Endosc 1999;49:442-6.)