Clinical study of argon plasma coagulation treatment of Barrett esophagus under endoscopy
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ObjectiveTo evaluate clinical efficacy on argon plasma coagulation(APC) treatment of Barrett esophagus(BE) under endoscopy.MethodsEighty-seven BE patients were diagnosed by endoscopy and pathology and treated by APC.Re-examined by endoscopy and pathology in the third month and sixth month after APC treatment.ResultsComplete squamous re-epithelialization were observed in 78 patients(89.7%) after 3 months,while remnant islands of columnar epithelium dispersedly in original lesion were observed in 9 patients(10.3%) and then retreated with APC.Complete squamous re-epithelialization were observed in all patients after six month.ConclusionAPC is a new therapeutic approach for BE without contact.It's more efficient and more convinent.Keywords:
Therapeutic Endoscopy
Endoscopic treatment
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Objective To explore the clinical effect of the argon plasma coagulation(APC) under endoscope combined with esomeprazole on Barrett′s esophagus(BE).Methods Fifty-two patients with Barrett′S esophagus confirmed by endoscope and pathology method were treated with APC and successive acid suppression therapy by esomeprazole for 8 weeks.All the patients were rechecked by endoscope and pathology method on 1,6 and 12 month after treatment.Results The follow-up was accomplished in all patients.The eradication was obtained in 40 cases by only one session and 10 cases by two sessions,2 cases by three sessions.The complete squamous reepithelialization was observed in 49 patients(94.2%),whereas remnant islands of columnar epithelium mixed with squamous reepithelialization in the original places were observed in 3 patients(5.8%).The reappearance of columnar epithelium was observed in 6 patients during follow-up.Conclusion The APC therapy combined with esomeprazole is effective and safe in the reversal of BE.However,recurrences and residual of BE occur in certain patients.
Esomeprazole
Endoscope
Barrett's esophagus
Endoscopic treatment
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Barrett's esophagus
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Esophageal disease
Barrett's esophagus
Endoscopic mucosal resection
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Objective To evaluate the clinical value and safety of argon plasma coagulation(APC) in the endoscopic treatment of intestinal precancerous lesion—intestinal polyps and adenoma.Methods From April 2004 to December 2007,17 outpatient cases with intestinal polyps and adenoma were examined under endoscopy and histopathology.They were treated by using APC under endoscopy.All cases were rechecked by endoscopy and histopathology after 6 months.Results Sixteen patients(94%) were disappeared in clinical symptoms.The endoscopic and histopathologic recheck shewed that the lesion area healed and had been covered by normal mucosa.The adenoma was remitted in clinical symptoms and reduced obviously in 1 patient(6%) who was treated again by APC.Conclusion APC is an alternative,non-touched technique via endoscopy and new method in the treatment of intestinal precancerous lesion.It can make the treatment simple, safe and effective.
Histopathology
Precancerous lesion
Intestinal mucosa
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[Objective] To assess the efficacy of argon plasma coagulation (APC) in the treatment of mature verrucosa gastritis. [Methods] 35 patients with mature verrucosa gastritis diagnosed by endoscopy and biopsy underwent APC therapy. Argon flow rate was 2 L/min and APC power ranged from 40 W to 60 W. After APC treatment, all patients received omeprazole therapy for two weeks. Clinical follow-up and another endoscopic examination were performed one month later. [Results] 146 verrucous lesions in 35 patients were ablated through APC therapy. Ablating frequency depended on the extent of lesions and the average time of treatment was 3.9 s (2~6 s). None of complications including bleeding or perforation happened. At the one month follow up, 31 patients (88.6%) had no symptom and endoscopic examination indicated that verrucous lesions became flatten and mucosal inflammation improved markedly. 4 patients (11.4%) still had digestive symptoms and endoscopic examination show slight or moderate improvement. [Conclusions] APC therapy is an effective and safe method for mature verrucosa gastritis.
Perforation
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Objective To explore the efficacy of argon plasma coagulation(APC) in treatment of upper digestive tract disease under endoscope.Methods 61 patients of upper digestive tract disease were treated by APC.Among 61 patients,26 cases were gastroesophageal polypus,13 cases were gastritis verrucosa,8 cases were Barrett′s esophageal,42 cases were upper gastrointestinal hemorrhage.Results For 26 cases of gastroesophageal polyp,the lesions were eliminated and no residual lesions were found when checked by endoscopy 3 months after APC treatment.For 13 case of gastritis verrucosa,all cases recovered thoroughly when checked by endoscopy 1 month after APC treatment.For 8 cases of Barrett′s esophageal treated with APC accompanied by drugs,2 case relapsed as shown by endoscopy and biopsy 1 year after the treatment.For 14 cases of upper gastrointestinal hemorrhage,no hemorrhage was found after APC treatment.Conclusion APC in treatment of upper digestive tract disease under endoscope has features of safety,effective ness,easy operation and less complications.
Endoscope
Digestive tract
Endoscopic treatment
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Background: Barrett's oesophagus is a premalignant condition. Recent reports have suggested that laser coagulation or photodynamic therapy combined with acid suppression may induce reconstitution of squamous mucosa. However, a high percentage of residual glands remain in cases treated with both techniques. Argon plasma coagulation (APC) appears to be an attractive alternative to other thermoablative techniques. The aim of this study was to investigate the reconstitution of squamous epithelium in Barrett's oesophagus after APC. Methods: Fifteen patients with histologically proven Barrett's oesophagus were included in a prospective study. After base-line documentation by videotaping and biopsies, Barrett's epithelium was treated by repeated APC at intervals of 4-6 weeks until complete squamous restoration was achieved. All patients were kept under high-dose proton pump inhibitor therapy. Results: In 13 patients complete reconstitution of squamous epithelium was achieved. Buried glands after squamous restoration were detected transiently in only one case after the first session. As side effects seven patients had mild retrosternal discomfort. One patient reported severe retrosternal pain for 1 week. He then refused further APC sessions. Another patient was excluded because of noncompliance. During the follow-up period (6-13 months) recurrence of Barrett's epithelium was observed in one patient. Conclusions: APC is a suitable technique for achieving squamous restoration in Barrett's oesophagus. The rare occurrence of remaining buried glands may result from the homogeneous coagulation achieved by the ionized argon gas beam.
Stratified squamous epithelium
Barrett's oesophagus
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Objective To explore the clinical effect of the argon plasma coagulation(APC) in the endoscopic treatment of Barrett esophagus(BE). Methods After the diagnosis as BE with endoscopy and pathohistolog y, 22 outpatients through May 2003 to Feb 2004 were treated with APC. The treatm ent time and operating times depended on the size and the number of the lesions. All the cases were re-checked by endoscopy in 1-3 months after APC. Results In 22 patients, one failed to be followed-up, one was not up to the follow-up time, and complete squamous reepithelialization was observ ed in 17 patients (85%), whereas remnant islands of columnar epithelium in the o riginal places were observed in 2 patients. Small new islands of columnar epithe lium in other places were observed in 1 patient during follow-up. Conclusion The clinical experience shows APC is a new non-touched endoscopic technique and it is a rather effective and convenient method in trea ting BE.
Barrett's esophagus
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Objective:The aim of this study was to investigate the efficacy and safety of argon plasma coagulation ( APC ) in the treatment of gastric polyps and verrucosa gastritis. Methods:30 patients diagnosed with gastric polyps and 50 patients diagnosed with verrucosa gastritis ( VG ) were enrolled. Endoscopic APC was administrated by using APC 300 ( ERBE Co. Germany ) with an argon gas flow of 2.4 L/min at a power setting of 60 W. All the patients were follow-up and the therapeutic efficacy and the complications were recorded 1 month after the treatment by repeat gastroscope. Results:APC was performed in 52 lesions of gastric polyps totally, 14 of which with diameter 1 cm that were treated by polypectomy and followed by APC for the residual lesions, whereas the remaining 38 lesions with diameter 1 cm were treated with APC only. After 1 month follow up, complete ablation was achieved in 27( 90.0% ) patients, residual lesions were observed in 1 patient and successfully re-ablated by APC. Otherwise, APC was performed in 271 lesions of mature verrcusa gastritis. After 1 month follow up , the clinical symptoms of 44 (88.0%) patients were improved along with the ablation achieved in 47 ( 94.0% ) patients represented the covered juvenile epithelium mucosae and granulation tissue without obvious scarring, however, residual lesions were only observed in 3 ( 6.0% ) patients and successfully retreated by APC. The overall complications of the treatment of APC occurred in some cases were recorded as pain at the treatment site and gaseous distention which remained no longer than 2 days. There was no other procedure related major complications. Conclusion:APC can be an alternative method in the treatment of gastric polyps and verrucosa gastritis with clinical satisfied benefits.
Polypectomy
Gastric Polyp
Granulation tissue
Endoscopic mucosal resection
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Squamous islands are frequently visualized at the time of upper endoscopy in patients with Barrett's esophagus, especially those on proton pump inhibitor therapy (PPI). The significance of these islands is not clearly understood. The aim of this study was to systematically biopsy macroscopic squamous islands and to examine their histologic characteristics.Patients with Barrett's esophagus undergoing surveillance had squamous islands documented and biopsied at the time of endoscopy. Barrett's esophagus was defined as the presence of a columnar lined esophagus on endoscopy with intestinal metaplasia on biopsy. All biopsies were obtained by a single senior endoscopist and were stained with alcian blue at pH 2.5. Biopsy samples with inadequate tissue quantity were not included in the study.A total of 39 biopsies were obtained from 22 patients. Twenty of the 22 patients were male, with a mean age of 65.4 yr (range 47-80 yr). The mean length of Barrett's mucosa was 5.6 cm (range 1-11 cm). Eleven of 22 patients were on omeprazole (mean dose 29.1 mg/day), whereas seven patients were on lansoprazole (60 mg/day). The mean duration of PPI therapy was 2.3 yr (range 9-71 months) at the time of biopsy of the squamous islands. Three patients were on H2-blocker therapy whereas the remaining patient had not been started on acid suppression therapy. On histology, 24 biopsy specimens (61.5%) revealed only squamous epithelium, whereas 15 (38.5%) showed the presence of intestinal metaplasia underlying the squamous epithelium. There was no significant difference between the patients with and without underlying intestinal metaplasia in regard to age, Barrett's length, dose, and duration of PPI therapy.In more than one-third of biopsies of macroscopic squamous islands within Barrett's esophagus, microscopic intestinal metaplasia is detected. The presence of squamous islands should not be equated with regression of Barrett's esophagus or with decreased cancer risk.
Barrett's esophagus
Squamous metaplasia
Intestinal metaplasia
Lansoprazole
Metaplasia
Histology
Esophageal disease
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