Background: Endoscopic ablation of Barrett’s esophagus has been described in which various thermocoagulation modalities are used in combination with a high d ose of a proton pump inhibitor. No randomized comparison o...Background: Endoscopic ablation of Barrett’s esophagus has been described in which various thermocoagulation modalities are used in combination with a high d ose of a proton pump inhibitor. No randomized comparison of ablation strategies has been published. Methods: Referred patients were screened to identify those w ith Barrett’s es- ophagus 2 to 7 cmin length,without high-grade dysplasia or cancer. Included p atients received pantoprazole (40 mg twice a day), followed by randomization to treatment with argon plasma coagulation (APC) or multipolar electrocoagulation ( MPEC). The primary outcome measure was the number of treatment sessions required for endoscopic ablation. Results: Of 235 patients screened, 52 were randomized. The mean length of Barrett’s esophagus was 3.1 cm in the MPEC group vs. 4.0 cm in the APC group (p = 0.03). Otherwise,the treatment groups were similar with re gard to baseline characteristics. The mean number of treatment sessions required for endoscopic ablation was 2.9 for MPEC vs. 3.8 for APC (p = 0.04) in an inten tion-to-treat analysis (p = 0.249, after adjustment for the difference in leng th of Barrett’s esophagus).The proportion of patients in which ablationwas endo scopically achieved proximal to the gastroesophageal junction was 88%for the MP EC group vs. 81%for the APC group (p = 0.68) and histologically achieved in 81%for MPEC vs. 65%for APC (p= 0.21). The mean ti me required for the first treatment session was 6 minutes with MPEC vs. 10 minut es with APC (p =0.01) in per protocol analysis. There was no serious adverse eve nt, but transient moderate to severe upper-GI symptoms occurred after MPEC in 8 %vs. 13%after APC (p = 0.64).Conclusions: Although there were no statistically significant differences, ablation of Barrett’s esophagus with pantoprazole and MPEC required numerically fewer treatment sessions, and endoscopic and histolog ic ablation was achieved in a greater proportion of patients compared with treat ment with pantoprazole and APC.展开更多
文摘Background: Endoscopic ablation of Barrett’s esophagus has been described in which various thermocoagulation modalities are used in combination with a high d ose of a proton pump inhibitor. No randomized comparison of ablation strategies has been published. Methods: Referred patients were screened to identify those w ith Barrett’s es- ophagus 2 to 7 cmin length,without high-grade dysplasia or cancer. Included p atients received pantoprazole (40 mg twice a day), followed by randomization to treatment with argon plasma coagulation (APC) or multipolar electrocoagulation ( MPEC). The primary outcome measure was the number of treatment sessions required for endoscopic ablation. Results: Of 235 patients screened, 52 were randomized. The mean length of Barrett’s esophagus was 3.1 cm in the MPEC group vs. 4.0 cm in the APC group (p = 0.03). Otherwise,the treatment groups were similar with re gard to baseline characteristics. The mean number of treatment sessions required for endoscopic ablation was 2.9 for MPEC vs. 3.8 for APC (p = 0.04) in an inten tion-to-treat analysis (p = 0.249, after adjustment for the difference in leng th of Barrett’s esophagus).The proportion of patients in which ablationwas endo scopically achieved proximal to the gastroesophageal junction was 88%for the MP EC group vs. 81%for the APC group (p = 0.68) and histologically achieved in 81%for MPEC vs. 65%for APC (p= 0.21). The mean ti me required for the first treatment session was 6 minutes with MPEC vs. 10 minut es with APC (p =0.01) in per protocol analysis. There was no serious adverse eve nt, but transient moderate to severe upper-GI symptoms occurred after MPEC in 8 %vs. 13%after APC (p = 0.64).Conclusions: Although there were no statistically significant differences, ablation of Barrett’s esophagus with pantoprazole and MPEC required numerically fewer treatment sessions, and endoscopic and histolog ic ablation was achieved in a greater proportion of patients compared with treat ment with pantoprazole and APC.
