Abstracts
1998 Digestive Disease Week

#2330

ENDOSCOPIC LASER ABLATION OF BARRETT'S MUCOSA FOLLOWED BY NISSEN FUNDOPLICATION: RESULTS OF A PILOT STUDY. A.Carazzone,L.Bonavina, A.Segalin, L.Antoniazzi, C.Ceriani, A.Peracchia. Dept. of General and Oncologic Surgery Milan, Italy.

The effect of endoscopic Nd:YAG laser ablation and omeprazole 40 mg/day was evaluated in 16 patients with Barrett's esophagus candidate to anti-reflux surgery. Methods. Laser treatment was performed with non contact fiber and a power output of 45 Watts after identification of Barrett's mucosa with lugol staining. Ten patients presented with tongues, 4 with circumferential, and 2 with short Barrett. No patient had associated dysplasia. Results. The mean number of treatments was 4, and the mean per-treatment energy 2800 Joules. Morbidity included 2 patients with a distal esophageal stricture treated with endoscopic dilation before anti-reflux surgery. A complete eradication, confirmed by multiple endoscopic biopsies, was recorded in both patients with short Barrett, in 7 of the 10 patients with tongues, and in 1 of the 4 patients with circumferential metaplasia. In 2 patients with tongues and in 2 patients with circumferential Barrett, only a partial eradication could be achieved despite repeated laser treatment. Two patients, 1 with tongues and the other with circumferential Barrett, were considered non-responders. In 1 patient with complete eradication, endoscopic biopsies revealed adenocarcinoma undermining regenerated squamous epithelium. This patient underwent esophago-gastric resection. Nissen fundoplication was performed in 10 of the remaining 15 patients. The median follow-up is 6 months (range 2-19); a recurrence of Barrett's esophagus was recorded in 4 patients: 2 with tongues who reached a complete eradication, and 2 with tongues and circumferential Barrett, respectively, who reached a partial response after laser treatment. All patients are still under endoscopic surveillance. Conclusions. Nd:YAG laser therapy of non-dysplastic Barrett's esophagus, performed under omeprazole treatment and followed by anti-reflux surgery, allows a reduction of the extension of columnar mucosa in most patients. However, Nd:YAG laser therapy is an expensive procedure which did not prove effective in reducing cancer risk, produced only temporary eradication, and did not obviate the need of endoscopic surveillance.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.