A clinical evaluation of argon plasma coagulation in Barrett´s esophagus mucosal ablation therapy / Avaliação da aplicação clínica da coagulação com plasma de argônio na ablação do esôfago de Barrett

AUTOR(ES)

Horus Antony Brasil

DATA DE PUBLICAÇÃO

2008

RESUMO

The aim of this study is to determine the effectiveness of the Argon Plasma Coagulation (APC) in ablation therapy of specialized columnar epithelium in Barrett´s esophagus. The presence of Barrett´s epithelium is considered a premalignant condition with potential development of adenocarcinoma. The incidence of esophageal adenocarcinoma has been rising for the past 3 decades A prospective study performed with a group of 30 patients(25 men/5 women) with 47 years mean age (range 12 to72) for the men and 49,9 years mean age ( range 45 to 60) for the women presented with Barrett´s esophagus demonstrated by endoscopy and histology.They were referred to us after antireflux surgery and were assimptomatic at the beginning of the study. Application of APC was carried out under sedation (midazolan and meperidine) with a gas flow of 2,5 l/min &70 w. The Barretts epithelium was coagulated from the most proximal to the gastrointestinal junction to the most distal limit. The maximum size treated each time was 4 cm long. Special care was taken on coagulation of the visible small islands of remaining intestinal metaplasia tissue. The treatment performed in large areas, bigger than 4 cm led to the increasing rate of complications and transient symptoms. The patients returned monthly to new session until complete ablation of the Barrett´s esophagus was showed by endoscopy. Then, 3 months later after that, a extensive random biopsies were taken to histology search for Barretts. The mean number of APC sessions was 2,1 (range 1 to 6). In two cases, endoscopy showed absence of intestinal metaplasia but histology shows small islands of intestinal metaplasia under the neosquamous epithelium. Two(6,6%) esophageal stenosis and one (3,3%) pneumomediastin case have been occurred. The follow up ranged to 27days to 4 years (mean one year and four months). Reepitelialization with squamous epithelium indistinguishable of the esophageal mucosa was demonstrated by endoscopy in 93,4%. There has been no relapse or evidence of the development of dysplasia. No deaths or major complication occurred in this study.

ASSUNTO(S)

plasma/efeitos de radiação argon/therapeutic use barrett esophagus/diagnosis esofagite péptica/complicações endoscopy digestive system endoscopia do sistema digestório barrett esophagus/therapy esôfago de barrett/diagnóstico argônio/uso terapêutico esophagitis peptic/complications plasma/radiation effects esôfago de barrett/terapia

Documentos Relacionados

• Revisão sistemática da literatura sobre as terapias endoscópicas ablativas do esôfago de Barrett
• Utilização de pHmetria de múltiplos canais para estudo de refluxo distal em pacientes em pós-operatório de fundoplicatura por esôfago de Barrett
• Avaliação comparativa do epitélio do esôfago de Barrett atráves da cápsula endoscópica do esôfago e endoscopia digestiva alta associada a cromoscopia com azul de metileno
• Termocoagulação endoscópica do esôfago de Barrett com plasma de argônio sob diferentes potências: análise histopatológica e de sintomas pós-procedimento
• Treatment of Barrett's esophagus by endoscopic laser ablation and antireflux surgery.