[Barrett esophagus with severe dysplasia in argon beam therapy]

A curative therapy of Barrett's esophagus is not established, yet. However, in prospective clinical research trials, a combined therapy of potent pharmacological acid suppression with superficial coagulation of metaplastic epithelium is examined. By local coagulation using photodynamic therapy, laser or argon plasma coagulation, a complete reconstitution of squamous epithelium should be achieved. We report on a case of a patient with Barrett's esophagus and low-grade dysplasia, who developed high-grade dysplastic cell formations under argon plasma coagulation therapy. As part of a clinical study, the patient was treated over a period of one year monthly. We monitored the result of the therapy over the period of one year with endoscopy, histolgical investigations and DNA image cytometry. Ultimately a decision in favour of a further surgical management was made. The diagnostic instruments to identify patients with a high risk for the development of adenocarcinoma are discussed.