Background and study aim: Argon plasma coagulation (APC) has been used to ablate dysplastic and nondysplastic
Barrett’s esophagus. We determined the longer-term efficacy of APC ablation within
two randomized controlled trials of APC versus surveillance for Barrett’s esophagus
in patients in whom gastroesophageal reflux was controlled by either surgery or proton
pump inhibitors.
Patients and methods: 129 patients (surgical trial 70, medical trial 59) with Barrett’s esophagus (nondysplastic
or low grade dysplasia) were randomly allocated to either ablation using APC or to
continuing endoscopy surveillance. Outcomes were determined at three time points:
short-term (12 months), mid-term (42 – 75 months) and long-term (> 84 months).
Results: In the APC groups, initial ablation of > 95 % of the Barrett’s esophagus was achieved
in 61 of 63 patients; the > 95 % ablation persisted in 47 of 56 patients at short-term
follow-up, in 33 of 49 at mid-term and in 21 of 32 at long-term follow-up. In the
surveillance groups, the length of Barrett’s esophagus reduced from a mean of 4.2 cm
to 2.7 cm at long-term follow-up. High grade dysplasia (HGD) developed in 1 patient
in the APC groups and in 3 in the surveillance groups. Low grade dysplasia developed
in 1 APC patient and in 6 surveillance patients.
Conclusions: APC ablation reduced the extent of Barrett’s esophagus, and this reduction was maintained
in some patients at longer-term follow-up. However, progression to HGD can still occur
despite APC ablation, suggesting endoscopic surveillance is still required.
Clinical trial registration: ACTRN012607000293460 and ACTRN12607000292471 (Australian
Clinical Trials Registry).
