Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus

Douglas Orrick Faigel, David A. Lieberman, Wilfred M. Weinstein, Shane Fanning, M. Brian Fennerty, Richard B. Sampliner

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown. Methods: Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up. Results: Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 ± 0.1 mm to 3.7 ± 0.1 mm (mean ± SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 ± 0.1 mm vs. 2.2 ± 0.1 mm) and the mid-body gastric wall thickness (2.9 ± 0.1 mm vs. 3.1 ± 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 ± 0.2 mm vs. 3.8 ± 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 ± 0.2 mm to 3.6 ± 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed. Conclusions: Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.

Original languageEnglish (US)
Pages (from-to)23-26
Number of pages4
JournalGastrointestinal Endoscopy
Volume55
Issue number1
DOIs
StatePublished - Jan 2002
Externally publishedYes

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Electrocoagulation
Barrett Esophagus
Metaplasia
Epithelium
Re-Epithelialization
Biopsy
Omeprazole
Proton Pump Inhibitors
Therapeutics
Thoracic Aorta
Surgical Instruments
Mouth
Stomach
Mucous Membrane

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Faigel, D. O., Lieberman, D. A., Weinstein, W. M., Fanning, S., Fennerty, M. B., & Sampliner, R. B. (2002). Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus. Gastrointestinal Endoscopy, 55(1), 23-26. https://doi.org/10.1067/mge.2002.120100

Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus. / Faigel, Douglas Orrick; Lieberman, David A.; Weinstein, Wilfred M.; Fanning, Shane; Fennerty, M. Brian; Sampliner, Richard B.

In: Gastrointestinal Endoscopy, Vol. 55, No. 1, 01.2002, p. 23-26.

Research output: Contribution to journalArticle

Faigel, DO, Lieberman, DA, Weinstein, WM, Fanning, S, Fennerty, MB & Sampliner, RB 2002, 'Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus', Gastrointestinal Endoscopy, vol. 55, no. 1, pp. 23-26. https://doi.org/10.1067/mge.2002.120100
Faigel, Douglas Orrick ; Lieberman, David A. ; Weinstein, Wilfred M. ; Fanning, Shane ; Fennerty, M. Brian ; Sampliner, Richard B. / Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus. In: Gastrointestinal Endoscopy. 2002 ; Vol. 55, No. 1. pp. 23-26.
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abstract = "Background: Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown. Methods: Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up. Results: Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 ± 0.1 mm to 3.7 ± 0.1 mm (mean ± SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 ± 0.1 mm vs. 2.2 ± 0.1 mm) and the mid-body gastric wall thickness (2.9 ± 0.1 mm vs. 3.1 ± 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 ± 0.2 mm vs. 3.8 ± 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 ± 0.2 mm to 3.6 ± 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed. Conclusions: Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.",
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AU - Faigel, Douglas Orrick

AU - Lieberman, David A.

AU - Weinstein, Wilfred M.

AU - Fanning, Shane

AU - Fennerty, M. Brian

AU - Sampliner, Richard B.

PY - 2002/1

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N2 - Background: Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown. Methods: Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up. Results: Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 ± 0.1 mm to 3.7 ± 0.1 mm (mean ± SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 ± 0.1 mm vs. 2.2 ± 0.1 mm) and the mid-body gastric wall thickness (2.9 ± 0.1 mm vs. 3.1 ± 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 ± 0.2 mm vs. 3.8 ± 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 ± 0.2 mm to 3.6 ± 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed. Conclusions: Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.

AB - Background: Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown. Methods: Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up. Results: Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 ± 0.1 mm to 3.7 ± 0.1 mm (mean ± SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 ± 0.1 mm vs. 2.2 ± 0.1 mm) and the mid-body gastric wall thickness (2.9 ± 0.1 mm vs. 3.1 ± 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 ± 0.2 mm vs. 3.8 ± 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 ± 0.2 mm to 3.6 ± 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed. Conclusions: Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.

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