Thermal ablation of Barrett's esophagus: a heated debate

A study reported in this issue of the American Journal of Gastroenterology has explored the efficacy of high-power argon plasma coagulation (APC) for the eradication of nonneoplastic Barrett's epithelium. Complete eradication was achieved in 77% of 48 patients, with a 10% rate of major complications including hemorrhage, esophageal stricture, and esophageal perforation. Although these observations indicate that high-power APC can eradicate Barrett's epithelium in some patients, it is not clear that this expensive and hazardous therapy conveys any clinical benefit. Even if one makes the substantial leap of faith that APC can decrease the risk of cancer in Barrett's esophagus, that risk is so small for patients without dysplasia that the number needed to treat is unacceptably large. Available data do not support the routine application of endoscopic ablative therapy for patients who have Barrett's esophagus without dysplasia.