Evaluación de la eficacia de la terapia ablativa con argón plasma en el esófago de Barrett con displasia: Seguimiento prospectivo no menor a un año
Por:
Castaño R., Álvarez O., Piñeres A., Ruiz M.H., Rojas A., Álvarez A., Ruiz L.M., Restrepo D., Calvo V.
Publicada:
1 ene 2014
Categoría:
Gastroenterology
Resumen:
Introduction: Barrett’s esophagus (BE) with dysplasia has a recognized potential for malignancy. Neither acid suppression nor anti-reflux surgery produce consistent or complete regression of metaplasia or dysplasia in the epithelium. Endoscopic argon plasma ablation (APC) offers the possibility of eradication, but factors that may influence the outcome of therapy have not been consistently evaluated. Objective: The objective of this study was to evaluate the efficacy of APC for eradication of BE with dysplasia and to evaluate the factors that infl uence the immediate outcome and results after one year of follow up. Methods: The study population included thirty-three patients suffering from BE with dysplasia: 19 men (58%), mean age of 56.9 ± 6.35 years (range 45-69 years) and an average length of EB 4.1 cm (range 2 to 8 cm.). All patients had undergone APC at intervals of 4 to 6 weeks to eradicate Barrett’s esophagus. Patients also received double doses of proton pump inhibitors (PPIs). Patients were endoscopically monitored at 3, 6 and 12 months and thereafter every year with four-quadrant biopsies of treated areas. Results: Ablation of BE and dysplasia was achieved in all patients after a median of 2 sessions of APC (1-4 sessions). Recurrence of BE and dysplasia is associated with longer initial lengths affected by BE and larger circumferences of its circular or proximal margin, despite treatment with additional APC sessions (no significant differences). Documented recurrences of Barrett’s esophagus occurred in seven patients (21.2%), documented recurrences of dysplasia occurred in three patients (9.1%). Two of these were low grade and one was high grade. The most frequent complication was chest pain which was experienced by six patients (18.2%), four had stenoses that required endoscopic dilatation (12.1%), and one patient’s (3%) bleeding required sclerotherapy during the procedure. The average follow-up time was 43.7 ± 19 months. Noesophageal carcinoma developed nor were there any deaths related to the disease or therapy. Conclusions: Treatment with APC is safe and effective ablative therapy for short segments of BE with dysplasia. Post treatment recurrences of BE and dysplasia are common especially among patients with long segments of BE. © 2014 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.
Filiaciones:
Castaño R.:
Cirugía Gastrointestinal y Endoscopia, Jefe de Postgrado Cirugía General U.P.B, Grupo Gastrohepatología Universidad de Antioquia, Instituto de Cancerología Clínica las Américas, Medellín, Colombia
Medellín, Colombia
Álvarez O.:
Universidad de Texas, Campo Regional San Antonio, Harlingen, TX, United States
Piñeres A.:
Clínica Bolivariana, Medellín, Colombia
Medellín, Colombia
Ruiz M.H.:
Hospital Pablo Tobón Uribe, Medellín, Colombia
Medellín, Colombia
Rojas A.:
Instituto de Cancerología-Clínica las Américas, Medellín, Colombia
Medellín, Colombia
Álvarez A.:
Medellín, Colombia
Ruiz L.M.:
Medellín, Colombia
Restrepo D.:
Medellín, Colombia
Calvo V.:
Medellín, Colombia
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