Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 10 cm - 11/08/11
Reprint requests: Jacques Bergman, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.Résumé |
Background |
Radiofrequency ablation (RFA) is safe and effective for eradicating Barrett's esophagus (BE) and BE-associated early neoplasia. Most RFA studies have limited the baseline length of BE (<10 cm), and therefore little is known about RFA for longer BE.
Objective |
To assess the safety and efficacy of RFA with or without prior endoscopic resection (ER) for BE ≥10 cm containing neoplasia.
Design |
Prospective trial.
Setting |
Two tertiary-care centers.
Patients |
This study involved consecutive patients with BE ≥10 cm with early neoplasia.
Intervention |
Focal ER for visible abnormalities, followed by a maximum of 2 circumferential and 3 focal RFA procedures every 2 to 3 months until complete remission.
Main Outcome Measurements |
Complete remission, defined as endoscopic resolution of BE and no intestinal metaplasia (CR-IM) or neoplasia (CR-neoplasia) in biopsy specimens.
Results |
Of the 26 patients included, 18 underwent ER for visible abnormalities before RFA. The ER specimens showed early cancer in 11, high-grade intraepithelial neoplasia (HGIN) in 6, and low-grade intraepithelial neoplasia (LGIN) in 1. The worst residual histology, before RFA and after any ER, was HGIN in 16 patients and LGIN in 10 patients. CR-neoplasia and CR-IM were achieved in 83% (95% confidence interval [CI], 63%-95%) and 79% (95% CI, 58%-93%), respectively. None of the patients had fatal or severe complications and 15% (95% CI, 4%-35%) had moderate complications. During a mean (± standard deviation) follow-up of 29 (± 9.1) months, no neoplasia recurred.
Limitations |
Tertiary-care center, short follow-up.
Conclusion |
ER for visible abnormalities, followed by RFA of residual BE is a safe and effective treatment for BE ≥10 cm containing neoplasia, with a low chance of recurrence of neoplasia or BE during follow-up.
Le texte complet de cet article est disponible en PDF.Abbreviations : APC, BE, CI, CR-IM, CR-neoplasia, EC, ER, HGIN, IM, IQR, LGIN, RFA
Plan
| DISCLOSURE: The project was financially supported by an unrestricted grant from AstraZeneca Netherlands to BLAM Weusten and JJGHM Bergman. JJGHM Bergman also received grantfunds from Barrx Medical, Inc. No other financial relationships relevant to this publication were disclosed. |
|
| If you would like to chat with an author of this article, you may contact Dr Bergman at j.j.bergman@amc.uva.nl. |
Vol 73 - N° 4
P. 682-690 - avril 2011 Retour au numéro
Article précédent
- Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos)
- Mohamad A. Eloubeidi, Jayant P. Talreja, Tercio L. Lopes, Basil S. Al-Awabdy, Vanessa M. Shami, Michel Kahaleh
- EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors
- Mouen A. Khashab, Elaine Yong, Anne Marie Lennon, Eun Ji Shin, Stuart Amateau, Ralph H. Hruban, Kelly Olino, Samuel Giday, Elliot K. Fishman, Christopher L. Wolfgang, Barish H. Edil, Martin Makary, Marcia Irene Canto
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?