Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results

Background: Barrett's esophagus is a premalignant lesion for esophageal adenocarcinoma. This study tests the hypothesis that re-injury of the metaplastic epithelium in an acid-controlled environment will result in reversal of Barrett's to squamous epithelium. Methods: Patients with at leas...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 1996-11, Vol.44 (5), p.532-535
Main Authors: Sampliner, Richard E., Fennerty, Brian, Garewal, Harinder S.
Format: Article
Language:English
Subjects:
Aged
Anti-Ulcer Agents - administration & dosage
Anti-Ulcer Agents - therapeutic use
Barrett Esophagus - pathology
Barrett Esophagus - therapy
Biological and medical sciences
Combined Modality Therapy
Electrocoagulation - methods
Epithelium - pathology
Esophagus
Female
Humans
Hydrogen-Ion Concentration
Male
Medical sciences
Middle Aged
Mucous Membrane - pathology
Omeprazole - administration & dosage
Omeprazole - therapeutic use
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
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Summary:Background: Barrett's esophagus is a premalignant lesion for esophageal adenocarcinoma. This study tests the hypothesis that re-injury of the metaplastic epithelium in an acid-controlled environment will result in reversal of Barrett's to squamous epithelium. Methods: Patients with at least 2 cm of Barrett's esophagus were treated with omeprazole, and half the circumference of the Barrett's was treated with multipolar electrocoagulation (MPEC); the other half served as an internal control. After 6 months, the remaining Barrett's esophagus was treated with MPEC. Results: Twenty-four hour esophageal pH of less than 4 averaged 1.8% on a mean dose of 56 mg/day of omeprazole. Ten patients had visual and biopsy elimination of the targeted section of Barrett's esophagus after an average of 2.5 MPEC sessions. The remainder of the Barrett's esophagus is being treated in 9 patients; currently 5 have no evidence of Barrett's. Conclusions: The combination of control of esophageal acid exposure and re-injury of the metaplastic epithelium reverses Barrett's esophagus to squamous epithelium as determined by endoscopy and biopsy. (Gastrointest Endosc 1996;44:523-5.)
ISSN:0016-5107
1097-6779
DOI:10.1016/S0016-5107(96)70004-4