The efficacy and safety of Argon Plasma Coagulation therapy in Barrett's esophagus

Thermo-ablation of Barrett's esophagus along with maximum acid suppression can induce re-epithelialization with squamous epithelium. Argon Plasma Coagulation (APC) is a new modality with a reported superficial depth of injury. Aim: To assess the technical feasibility, safety and early results of APC in Barrett's esophagus. Methods: Patients with circumferential Barrett's esophagus of at least 3 cm in length and without dysplasia were prospectively enrolled. APC was applied in one session to only one-half of the circumference (the other half served as control) until a white coagulum was observed. Time required to provide APC therapy, immediate and delayed events and complications were monitored. Each patient was kept on 60 mg/day of lansoprazole. EGD with biopsies every 1 cm from treated and untreated areas were repeated 4 weeks later using a jumbo biopsy forceps. Biopsies were examined by a pathologist blinded to the treated areas. Presence of endoscopically-appearing squamous epithelium in the treated areas and mucosal damage were evaluated at each follow-up. Setting: GI Section VA Medical Center. Results: Ten patients (51.9±1.9 years) with circumferential Barrett's esophagus (mean length: 3.2 cm) were enrolled. APC was applied using a 3.2 mm probe and settings of A60 watts with flow rates of 1.6mL/min. The mean time required to treat half of the circumference was 9.8 min. Two (20%) patients experienced mild-moderate but self-limited chest pain during the endoscopic session. Four (40%) patients had chest discomfort for 3-5 days after the procedure. There were no perforations. Eight patients have returned for endoscopic follow-up and endoscopically-appearing squamous epithelium in the APC treated areas was evident in all of them. Superficial ulcerations in the APC-treated areas were seen in 3 patients. No strictures were seen. The non-treated areas were read as Barrett's esophagus in all 8 patients at follow-up. Biopsies from the APC-treated areas uniformly revealed normal squamous epithelium in all patients. Three of 8 (37.5%) patients had evidence of intestinal metaplasia underneath the squamous epithelium. Conclusions: 1) APC resulted in re-epithelialization with normal superficial squamous epithelium. 2) Although APC was effective in squamous re-epithelialization, one-third of patients still showed abnormal metaplastic tissue underneath on histology. 3) At the settings used, APC was safe but it caused minor chest discomfort in 40% patients.