Ablation of residual Barrett’s epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs. surveillance (APE study)

Hendrik Manner; Thomas Rabenstein; Oliver Pech; Kirsten Braun; Andrea May; Juergen Pohl; Angelika Behrens; Michael Vieth; Christian Ell

doi:10.1055/s-0033-1358813

Endoscopy, Table of Contents

Endoscopy 2014; 46(01): 6-12
DOI: 10.1055/s-0033-1358813

Original article

Ablation of residual Barrett’s epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs. surveillance (APE study)

Authors

Hendrik Manner

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany
Thomas Rabenstein

²Department of Internal Medicine, Diakonissen Stiftungskrankenhaus, Speyer, Germany
Oliver Pech

³Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
Kirsten Braun

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany
Andrea May

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany
Juergen Pohl

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany
Angelika Behrens

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany
Michael Vieth

⁴Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany
Christian Ell

¹Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany

Abstract

Background and study aim: It is commonly assumed that ablation of any remaining Barrett’s epithelium after endoscopic resection of early Barrett’s neoplasia improves outcome by reducing the rate of metachronous lesions, but this has not yet been evaluated in a randomized trial. The aim of this study was to compare argon plasma coagulation (APC) with surveillance only for the management of residual Barrett’s epithelium following endoscopic resection.

Patients and methods: Patients in whom focal early Barrett’s neoplasia (high grade intraepithelial neoplasia [HGIN] or mucosal cancer) had been curatively resected by endoscopy were randomly assigned to undergo ablation of the residual Barrett’s segment by APC or surveillance only; pH-metry-adjusted proton pump inhibitor therapy was administered in both groups. The main outcome parameter was recurrence-free survival. Follow-up endoscopies with biopsies in cases of further residual Barrett’s epithelium were carried out at 6-monthly intervals in both groups.

Results: A total of 63 patients (57 male [90.5 %]) were included in the study (ablation group n = 33; surveillance group n = 30). For complete Barrett’s ablation, a mean number of 4 ± 1.6 APC sessions were required (range 2 – 7). The mean follow-up duration did not differ significantly between ablation (28.2 ± 13.7 months, range 0 – 44) and surveillance patients (24.7 ± 14.8 months, range 0 – 45; P = 0.159). The number of secondary lesions was 1 in the ablation group (3 %), and 11 in the surveillance group (36.7 %), leading to significantly higher recurrence-free survival for the patients undergoing ablation (P = 0.005).

Conclusions: Thermal ablation of residual Barrett’s epithelium leads to a significant reduction in neoplasia recurrence rate compared with a surveillance strategy during a limited follow-up of 2 years. A longer follow-up duration may have led to a relatively higher rate of secondary neoplasia in both groups of patients.

Full Text

References

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