The first cases of Barrett esophagus (BE) ablation in the late 1980s used YAG and Argon laser. Since then, a myriad of ablation techniques have been described, including multipolar electrocautery (MPEC), argon plasma coagulation (APC), cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). Each technique has had its advocates, and some of the techniques appear to have certain advantages in certain types of BE: e.g., long segment, nodular, etc.
Most cases of BE are short segment, and most neoplastic cases do not have nodules or erosions. So the question I would like to see discussed is: In a patient with 1–2 cm of otherwise featureless flat but neoplastic BE:
What ablation technique would you use, and what do you feel makes this technique advantageous? Read more »
*This blog post was originally published at Gut Check on Gastroenterology*
The physical scars will be nothing compared to the emotional scars that will haunt the children. I recently read that the effective acne treatment Accutane was pulled off the market this summer quietly ending access to an excellent and effective acne treatment for millions of self conscious teens and young adults. Accutane, or isotretinoin as it’s known, was used to treat severe nodular acne.
It turns out that Accutane was linked to inflammatory bowel disease, and other side effects resulting in thousands of lawsuits. It spent twenty five years on the market embroiled in controversy.
Approved by the Food & Drug Administration (FDA) in 1982, Accutane has been the subject of controversy for years. It first garnered attention in the late eighties for causing severe birth defects. It has also been known to cause psychiatric problems, and has been linked to hundreds of cases of suicide in the United States. Accutane has also been associated with problems of the liver, kidneys, central nervous system, and pancreas, as well as the cardiovascular, musculoskeletal and auto-immune systems.
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*This blog post was originally published at The Happy Hospitalist*