Morphological state and COX-2 expression of the gastro-esophageal junction in patient’s with Barrett’s esophagus before and after argon plasma coagulation (APC) and laparoscopic Nissen fundoplication (LNF) ; Barrett’s esophagus (BE), laparoscopic Nissen fundoplication (LNF), argon plasma coagulation (APC), COX-2
BACKGROUND Progression from Barrett’s esophagus (BE) to adenocarcinoma may be avoided by antireflux surgery or prolonged proton pump inhibitors (PPI’s) therapy, whereas regeneration of esophageal mucosa could be achieved by endoscopic ablative therapy such as argon plasma coagulation (APC). AIMS In the light of described facts examinations were undertaken, of which an attempt of the evaluation was a purpose: - usefulnesses of the method of ablation with APC in removing metaplastic mucosa of the distal segment of the esophagus and getting the effect of squamous re-epithelialization - of laparoscopic Nissen fundoplication (LNF) in holding the effect re-epithelialization after APC, in the comparison for treating with the treatment with PPI's - monotherapy with PPI’s (pantoprazole 80 mg/day) in getting the effect of re-epithelialization in patients with BE - usefulnesses of markings of the expression COX- 2 in monitoring BE patient's in the aspect of determining the risk of the development of the adenocarcinoma. MATERIALS Sixty patients with histological proven BE were treated between January 2005 and December 2008. RESULTS Our results show that the combination of APC and laparoscopic Nissen fundoplication is a safe and effective treatment option for most patients with BE without high degree dysplasia. Simple PPI’s therapy without ablation of Barrett’s epithelium give inadequate results. Long-term follow-up of therapy is necessary to evaluate its effect on cancer risk reduction in Barrett's esophagus.