Ablation with Laser Therapy

Two types of lasers have been used to ablate Barrett's epithelium, Nd:YAG (1064 nm; depth ofinjury 3 to 4 mm), and KTP (532 nm; depth of injury 1 mm) (Eisen, 2003). Table 15-1 summarizes selected studies evaluating the success of laser therapy to achieve complete ablation of Barrett's epithelium. Most trials report eradication rates of approximately 70 to 80% with laser therapy and complication rates of 0 to 17% (Luman et al, 1996; Weston and Sharma, 2002).

Bonavina and colleagues (1999) prospectively evaluated Nd:YAG laser eradication of Barrett's epithelium. They documented eradication in 8 of 12 patients with tongues of Barrett's, 1 of 4 patients with circumferential Barrett's epithelium, and in both patients with short-segment Barrett's epithelium. In addition, 1 patient progressed in a 6-month period to develop AC underneath regenerated squamous epithelium. It is apparent that in some patients, although the superficial mucosa regenerates with normal squamous epithelium (also known as "neo-squamous epithelium"), deep mucosal islands of Barrett's epithelium and/or carcinoma may develop. These islands are not endo-scopically visible, may occur with any type of ablative therapy, and represent a failure of ablative therapy.

The remaining published studies in Table 15-1 evaluated the success of laser ablation therapy in patients with dysplastic (predominantly high grade) and early AC. Collectively, the complete response rate averaged 80%, with a mean follow-up period of 16.5 months (Salo et al, 1998; Gossner et al, 1998; Weston and Sharma, 2002). The complication rate ranged from 0 to 17.6%, and primarily included stricture formation requiring dilation for management. The most commonly reported side effects included odynophagia, early dysphagia, and chest pain. Laser may be best suited for small areas of dysplastic Barrett's epithelium or cancer, especially if a clinician decides to use a second mode of ablative therapy for residual short segment dysplastic Barrett's epithelium.

Constipation Prescription

Constipation Prescription

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