High-Energy Laser Therapy of Barrett’s Esophagus: Preliminary Results
Corresponding Author
Lorenzo Norberto M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
[email protected]Search for more papers by this authorLino Polese M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorImerio Angriman M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorFrancesca Erroi M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorAttilio Cecchetto M.D.
Istituto di Anatomia Patologica, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorDavide F. D’Amico M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorCorresponding Author
Lorenzo Norberto M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
[email protected]Search for more papers by this authorLino Polese M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorImerio Angriman M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorFrancesca Erroi M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorAttilio Cecchetto M.D.
Istituto di Anatomia Patologica, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorDavide F. D’Amico M.D.
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy
Search for more papers by this authorAbstract.
We present the preliminary results obtained by our research group utilizing Nd:YAG and diode lasers to treat Barrett’s esophagus (BE). A total of 15 patients with BE (mean age 58 years) underwent endoscopic laser therapy: 11 with intestinal metaplasia, 2 with low-grade dysplasia, and 2 with high-grade dysplasia. The mean length of BE was 4 cm (range 1–12 cm). Six of these patients also underwent antireflux surgery, and nine were prescribed acid-suppressive medication. Endoscopic Nd:YAG laser treatment was carried out from 1997 to 1999; thereafter, diode laser was employed. The mean follow-up of these patients after the first laser session was 28 months. Patients underwent a mean of 6.5 laser sessions (range 3–17 sessions), with no apparent complications. The mean energy per session was 1705 JJ. Only six of these patients (40%) showed complete endoscopic and histologic remission, but a mean of 77% (SD 23.8%) of the total metaplastic tissue in all these patients was ablated. The percentage of healed mucosa was higher in patients with short-segment BE (92%) (p < 0.05) and in subjects treated by two or more laser sessions per centimeter of BE length (89%) (p < 0.05). All four patients with dysplasia showed histologic regression to nondysplastic BE or to squamous epithelium, without recurrence during a mean follow-up of 30 months. The patients who underwent antireflux surgery and those prescribed pharmacologic treatment had similar results. Nd:YAG and diode laser treatment of BE is a safe, effective procedure; it required two sessions per centimeter of metaplasia; and it achieved complete regression of the dysplasia. Further studies are necessary to quantify its effect on cancer incidence.
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