Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: Preliminary results

Background: Barrett's esophagus is a premalignant lesion for esophageal adenocarcinoma. This study tests the hypothesis that re-injury of the metaplastic epithelium in an acid-controlled environment will result in reversal of Barrett's to squamous epithelium. Methods: Patients with at least 2 cm of Barrett's esophagus were treated with omeprazole, and half the circumference of the Barrett's was treated with multipolar electrocoagulation (MPEC); the other half sewed as an internal control. After 6 months, the remaining Barrett's esophagus was treated with MPEC. Results: Twenty-four hour esophageal pH of less than 4 averaged 1.8% on a mean dose of 56 mg/day of omeprazole. Ten patients had visual and biopsy elimination of the targeted section of Barrett's esophagus after an average of 2.5 MPEC sessions. The remainder of the Barrett's esophagus is being treated in 9 patients; currently 5 have no evidence of Barrett's. Conclusions: The combination of control of esophageal acid exposure and reinjury of the metaplastic epithelium reverses Barrett's esophagus to squamous epithelium as determined by endoscopy and biopsy.