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Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus
Douglas O Faigel1, David A Lieberman, Wilfred M Weinstein
1Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon, 97201, USA.
Background:
Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown.
Methods:
Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up.
Results:
Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 +/- 0.1 mm to 3.7 +/- 0.1 mm (mean +/- SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 +/- 0.1 mm vs. 2.2 +/- 0.1 mm) and the mid-body gastric wall thickness (2.9 +/- 0.1 mm vs. 3.1 +/- 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 +/- 0.2 mm vs. 3.8 +/- 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 +/- 0.2 mm to 3.6 +/- 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed.
Conclusions:
Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.