Diagnostics and treatment of Barret's esophagus

For the purpose of treatment optimization of patients with Barret's esophagus depending on clinical and pathogenic features of the process we analyzed results of treatment of 63 patients. In 12 cases visual thickening of metaplastic mucous membrane with a lot of dysplastic foci were revealed, in 13 – moderate dysplastic changes, in 8 – severe dysplasia. Segment of metaplastic epithelium with spots of specialized intestinal sized 1–3 cm were found in 9 patients, 3–10 cm – in 47, more than 10 cm – in 7. Diagnostics included: videoesophagogastroscopy with biopsy, 24-hours pH-metrics, roentgenoscopy of esophagus and stomach, in a case of neoplasm – endosonography of esophagus, in 7 cases – immunohystochemical investigation. For endoscopy we used methods to improve visualization quality. Depending on clinical and pathogenic features of disease for the metaplastic focus deletion the following methods were used: the fulguration in the air, resection of mucous fragment combined with argon plasma ablation and epithelial neoplasm resection with the fulguration in the air. In our opinion, complex treatment of patients with Barret's esophagus should include following interventions: the fulguration in the air or argon plasma ablation of metaplastic mucous combined with its resection, conservative treatment with proton pump inhibitors during 1–2 month and anti-reflux operation after epithelium regeneration. Interventions are characterized by low traumaticity, short duration of hospital – 1–2 days.

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