Plasma versus mucosectomía con bandas en el manejo endoscópico del esófago de Barrett con displasia o el carcinoma de esófago in situ
Por:
Castaño R., Álvarez Ó., Piñeres A., Ruiz M.H., Rojas A., Álvarez A., Ruiz L.M., Restrepo D., Calvo V.
Publicada:
1 ene 2014
Categoría:
Gastroenterology
Resumen:
Introduction: Various endoscopic techniques for ablation of metaplastic esophageal epithelia which maintain the integrity of the submucosa have been described. All maintain patients under aggressive acid suppressive therapy with proton pump inhibitors. To date, few studies have compared the different endoscopic techniques for eradicating Barrett’s esophagus (BE) with dysplasia. Similarly the factors that might infl uence patients’ prognoses after these therapies have not been very consistently evaluated. Objective: This is a pilot study which compares the effectiveness of complete eradication of BE with dysplasia through endoscopic mucosal resection (EMR) with bands and low voltage endoscopic argon plasma coagulation (APC). The three points evaluated are whether complete ablation of BE was achieved, the number of sessions required and whether and what complications occurred. Methods: APC was performed using a fl exible 10 French catheter. The voltage used was 50 W and flow timed varied between 1 minute and 2 l/min. In one group BE mucosa was treated with multi-band ligation. Up to six bands were placed per session. The mucosa with BE was removed with a polypectomy loop and a mixed stream of water. Patients were followed up endoscopically and biopsies were obtained from the four quadrants in both treated and untreated areas at three, six and twelve months after treatment ended. All patients received high doses of proton pump inhibitors. Results: This prospective study describes our results in a group of 62 patients with Barrett’s Esophagus and dysplasia. Thirty-three patients (22 men, 67%) were treated with APC and 29 were treated with EMR (19 men, 66%). Complete ablation of BE was achieved in 86.2% of patients treated with EMR and in 79% of those treated with APC. The number of sessions required to achieve complete ablation was 1 ± 1 for EMR and 2 ± 1 for APC. No major complications such as gastrointestinal bleeding requiring transfusion or perforations occurred. The only complications were two cases of esophageal stenosis, one in each group. These were successfully treated with single sessions of dilation. After a mean of 68.7 ± 18.9 months of follow-up in the APC group and 50.2 ± 19.3 months in the EMR group no cases of carcinoma of the esophagus and no deaths due to disease or therapy had occurred. Conclusions: In patients with BE with high or low grade dysplasia, APC and EMR achieve comparably high eradication rates of neoplasia and intestinal metaplasia (79% versus 86%). Both procedures have comparable levels of effectiveness and safety and have low rates of complications. Nevertheless, APC is associated with a greater number of sessions. © 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 Ó.:
Gastroenterólogo, Texas Valley Coastal Bend (Veterans Administration), UTHSCSA, Estados Unidos, United States
Piñeres A.:
Cirujano General, Clínica Bolivariana, Medellín, Colombia
Medellín, Colombia
Ruiz M.H.:
Cirujano General, Hospital Pablo Tobón Uribe, Medellín, Colombia
Medellín, Colombia
Rojas A.:
Cirujano General, 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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