Banding without resection (endoscopic mucosal ligation) as a novel approach for the ablation of short-segment Barrett's epithelium: Results of a pilot study

OBJECTIVES: During an endoscopic variceal ligation, we banded a varix with an overlying tongue of Barrett's epithelium (BE). One month later, the tongue was no longer visible, suggesting that banding could be used to eradicate BE. AIM: To assess the safety and efficacy of banding without resection (BWR) using a variceal banding device for eradicating BE. METHODS: From April 2004 through September 2005, 30 patients with BE were treated with BWR plus omeprazole 20 mg t.i.d. BWR was repeated monthly until two consecutive endoscopic and histological examinations showed no BE. Thirty Barrett's patients treated with omeprazole 20 mg t.i.d. alone served as a control group. RESULTS: The BWR treatment group comprised 29 patients with short-segment BE (SSBE) and one with long-segment disease, whereas all 30 of the control patients had SSBE. During a median follow-up of 16.9 months (range 10-24 months), complete eradication of BE was achieved in 29 of 30 patients (97%) in the BWR group. In contrast, BE persisted in all 30 control patients during the same period (P < 0.0005). The mean total number of bands applied per patient was 6.1 (range 1-14) and the mean number of sessions for complete eradication was 3.1 (range 1-7). Adverse events included only mild chest pain and dysphagia that resolved within days. CONCLUSIONS: BWR appears to be a safe, effective, simple, and widely available technique for eradicating SSBE. This is a pilot study and we do not recommend the ablation of nondysplastic BE at this time. Further studies are needed.