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Sixteen-year follow-up of Barrett's esophagus, endoscopically treated with argon plasma coagulation.
[esophageal adenocarcinoma]
The
thermal
destruction
of
non-
dysplastic
Barrett
's
esophagus
(
BE
)
and
its
replacement
by
squamous
epithelium
is
an
attractive
,
but
unproven
strategy
to
avoid
further
development
of
dysplasia
or
cancer
.
The
goal
of
this
study
was
to
estimate
the
persistence
of
restoration
of
squamous
epithelium
and
the
risk
of
cancer
in
BE
that
was
eradicated
using
argon
plasma
coagulation
(
APC
)
in
the
absence
of
high
-grade
dysplasia
,
16
years
after
its
application
.
We
followed
32
patients
with
BE
who
underwent
eradication
of
metaplastic
epithelium
using
APC
,
up
to
16
years
later
.
At
the
end
of
the
initial
treatment
,
25
of
32
patients
(
78
%
)
had
complete
endoscopic
eradication
,
there
was
partial
squamous
re
-epithelialization
in
four
patients
(
13
%
)
and
it
was
absent
in
three
patients
(
9
%
)
.
We
observed
buried
metaplastic
glands
under
new
squamous
epithelium
in
6
of
the
25
patients
who
had
complete
endoscopic
eradication
.
At
follow-up
,
sustained
complete
endoscopic
eradication
was
observed
in
16
of
32
patients
(
50
%
)
,
partial
eradication
in
11
of
32
patients
(
35
%
)
;
there
were
two
patients
(
6
%
)
lost
to
follow-up
and
three
patients
(
9
%
)
developed
esophageal
adenocarcinoma
.
Two
of
the
latest
cases
arose
from
the
buried
glands
under
neosquamous
epithelium
after
complete
eradication
and
one
arose
from
a
small
remaining
Barrett
's
segment
.
We
observed
long
-term
re
-epithelialization
in
the
majority
of
patients
who
had
previously
had
complete
eradication
of
Barrett
's
esophagus
.
This
did
not
provide
protection
against
cancer
development
,
as
the
incidence
of
cancers
arising
from
buried
glands
or
from
residual
Barrett
's
esophagus
was
similar
to
that
observed
in
patients
undergoing
no
specific
treatment
.
Diseases
Validation
Diseases presenting
"partial eradication"
symptom
esophageal adenocarcinoma
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