Eradication of Barrett's epithelium does not alter esophageal motility, lower esophageal sphincter function, or mural characteristics

Ablation of Barrett's epithelium (BE) in an anacidic environment facilitates squamous reepithelialization. The impact of thermal therapy on esophageal motility, lower esophageal sphincter function and the esophageal wall is unknown. Aims: To determine the effects, if any, of thermal ablation of BE on esophageal function and mural characteristics as assessed by endosonography (EUS). Methods: Three patients with BE, 2-5 cm, without dysplasia, underwent gastric analysis and 24 hr pHmetry in the presence of high dose antisecretory therapy (to confirm adequate control of esophageal acid exposure), esophageal manometry, EUS, and biopsies before and after laser photoablation (Nd:YAG or KTP), supplemented with multipolar electrocautery, at 4 week intervals as needed until reepithelialization was complete. Results: Gastric acid output and distal esophageal acid exposure were controlled in all patients throughout the therapy (2 with omeprazole 20 mg BID, 1 with 40 mg BID). The BE lengths were 2, 3, & 5 cm. The number of sessions to achieve eradication (confirmed by endoscopy and biopsy) were 1, 3, & 4 respectively. Measurements of lower esophageal sphincter pressure, distal esophageal contraction amplitude, duration and velocity and percentage of ineffective or non-peristaltic contractions did not change significantly after therapy. EUS demonstrated no change in mural thickness nor disruption of the wall layer pattern. Conclusions: Thermal ablation of short-segments of BE does not appear to cause deterioration or improvement of esophageal function nor alter mural characteristics.