Endoscopic management of Barrett's esophagus

Barrett's esophagus [BE] has a malignant potential. Neither acid suppression nor anti reflux surgery produce consistent or complete regression of metaplastic epithelium. Is to determine the efficacy of endoscopic therapy in management of BE. This study was carried out on 25 patients [18 males and 7 Females], with BE that was confirmed by biopsy and histopatholoay. According to the histopathological examination, 24 patients had BE with no dysplasia or low-grade dysplasia [LGD]. Ablation of Barrett's mucosa in those patients was done using argon plasma coagulation [APC]. Also, one patient who had [BE] with high-grade dysplasia [HGD]. Ablation of Barrett's mucosa in this patient was done using EMR [endoscopic mucosal resection]. As regards APC, successful ablation was achieved with complete clearance of BE in [71%] of patients and during the follow-up period only [12%] of those patients revealed buried BE glands on histopathological examinations. Complications as self-limiting chest discomfort [25%], odynophagia [20%], and temporary dysphagia [4%] were observed during the follow-up period. As regards EMR, it was performed only in one patient who had BE with HGD. The procedure was performed using lift and cut technique. EMR in this study was successful with no complications. Argon plasma coagulation [APC] ablative therapy for [BE] proved to be safe and well tolerated, with only minor self-limiting side effects. -Endoscopic mucosal resection [EMR], in ablation of BE with HGD, is an emerging and promising technique in treatment of 4splastic and malignant lesions within BE

Tratamento endoscópico de lesões sangrantes do trato gastrointestinal por meio de eletrocoagulação com argônio / Endoscopic treatment of bleeding lesions of the gastrointestinal tract by argon plasma coagulation

Introdução e objetivos: A eletrocoagulação com argônio (APC) é um método térmico de não-contato que pode ser utilizado como alternativa ao laser em endoscopia. Um amplo espectro de indicações têm sido propostas para tratamento através de APC, desde a introdução do uso em endoscopia, em 1991. O objetivo deste estudo é avaliar a eficácia do uso do APC na hemostasia endoscópica de lesões sangrantes do esôfago, estômago, duodeno, cólon e reto. Metodologia: Um total de 22 pacientes consecutivos (14M/8F, média de idade 66,7 anos) foram submetidos ao tratamento com APC entre 1998 e fevereiro de 2002. As causas de sangramento incluíam retite actínica (12 pacientes), ectasia vascular do antro gástrico (GAVE) ­ watermelon stomach (6 pacientes), angiodisplasias de esôfago, estômago e cólon (2 pacientes), gastrite actínica (1 paciente) e síndrome de Osler-Weber-Rendu (1 paciente). Resultados: Um total de 49 sessões foram realizadas (média de 2,2 sessões por paciente). Sucesso no tratamento endoscópico foi obtido em 18 pacientes (85,8%). Complicações foram observadas em 3 pacientes: 2 apresentaram dor local após as sessões de APC e um paciente desenvolveu estenose retal tratada com sucesso em uma sessão de dilatação endoscópica. Não houve mortalidade relacionada ao método. Conclusões: APC é um método seguro, efetivo, de relativo baixo custo e boa aceitação pelos pacientes para o tratamento de lesões sangrantes do trato gastrointestinal. Deve, portanto, ser considerado método de primeira escolha no tratamento dessas afecções (AU)

Background and aims: Argon plasma coagulation (APC) is an innovative non-touch electrocoagulation technique. A broad spectrum of indications has been proposed for APC since its introduction into endoscopy in 1991. The aim of this study is to evaluate the efficacy of utilizing APC in the endoscopic hemostasis of bleeding lesions of the esophagus, stomach, duodenun, colon and rectum. Methodology: A total of 22 consecutive patients (14M/ 8 F, mean age 66.7 years) underwent APC treatment between 1998 and february 2002. Causes of bleeding included radiation colitis (12 patients), gastric antral vascular ectasia ­ watermelon stomach (6 patients), esophagus,stomach and colon angiodysplasia (2 patients), radiation gastritis (1 patient) and Osler-Weber-Rendu Syndrome (1 patient). Results: A total of 49 sessions were performed (mean 2.2 sessions / patient). Succesful endoscopic APC treatment was achieved in 18 patients (85,8%). Complications were observed in 2 patients that referred local pain after therapy and 1 patient that developed a rectal stenosis succesfully reversed in one session of endoscopic dilation. No mortality related to APC was observed. Conclusions: APC is a safe, effective, and relative low-cost hemostatic modality for bleeding vascular lesions of the gastrointestinal tract. Therefore, APC should be considered as a first-line therapy for these conditions (AU)