HP22 FIVE YEAR RESULTS OF A PROSPECTIVE RANDOMISED CONTROLLED TRIAL OF ARGON PLASMA COAGULATION VS ENDOSCOPIC SURVEILLANCE OF PATIENTS WITH BARRETT’S OESOPHAGUS AFTER ANTIREFLUX SURGERY

Background  Argon plasma coagulation (APC) has been used to ablate Barrett’s oesophagus, although the long-term efficacy is unknown. This study reports the 5 year results of APC ablation vs surveillance of Barrett’s in post-fundoplication patients. Methods  43 post-fundoplication patients with Barrett’s oesophagus were randomised to either APC ablation of Barrett’s or surveillance. 40 have been followed up with endoscopic surveillance for a mean of 68 months to assess treatment efficacy, safety and the durability of the neosquamous re-epithelialisation. Results  A median of 2.5 (range 1–6) APC treatment sessions was required to reach >95% ablation of Barrett’s. Both groups had a significant (p  95% ablation of their Barrett’s, with 8 of 14 (57%) having no macroscopic or histologic evidence of Barrett’s. 4 of 20 surveillance patients (20%) had complete reversal of their Barrett’s, with 3 of 4 (75%) having no macroscopic or histologic evidence for Barrett’s. 2 patients in the APC group developed strictures requiring dilation. 2 patients in the surveillance group developed HGD during follow-up, while none did in the APC group. Conclusions  40% of post-fundoplication patients with APC ablation of Barrett’s retain this reversal beyond 5 years. 20% of Barrett’s patients post-fundoplication regress to normal squamous mucosa. Post-fundoplication Barrett’s surveillance patients continue to develop HGD, this has not been seen in the APC group.