Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus–related dysplasia is safe and effective - 13/08/15
Abstract |
Background |
Radiofrequency ablation (RFA) is an effective treatment for Barrett’s esophagus (BE) dysplasia. For patients with dysplasia refractory to RFA, data are limited regarding efficacy of endoscopic therapy.
Objective |
To assess the efficacy and safety of cryotherapy in patients with BE dysplasia who failed RFA.
Design |
Single-center, retrospective, cohort study.
Setting |
Tertiary-care center between 2006 and 2013.
Patients |
Patients with BE and low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (IMC) were referred for RFA every 2 to 3 months. Response was determined by complete eradication of dysplasia (CE-D).
Interventions |
Patients without CE-D or those with recurrent dysplasia after initial eradication were offered cryotherapy.
Main Outcome Measurements |
Eradication of dysplasia and/or cancer. Secondary outcome, eradication of intestinal metaplasia.
Results |
A total of 121 patients underwent RFA for BE dysplasia (55% HGD, 26% LGD, 17% IMC, 2% indefinite dysplasia). After a median of 3 RFA sessions, 75% (n = 91) had CE-D. Patients without CE-D were more likely to have a longer BE length (7 cm vs 4 cm; P = .004) and a hiatal hernia (83% vs 55%; P = .005). Sixteen patients (14 with failed CE-D and 2 with recurrent dysplasia) were offered cryotherapy and had endoscopic follow-up. Seven (57%) had HGD before cryotherapy (6 with LGD, 2 with IMC, and 1 with indefinite dysplasia). After cryotherapy, 12 (75%) had CE-D, and 5 (31%) had eradication of intestinal metaplasia. Of patients with IMC, 100% had CE-D. Three patients developed strictures that responded to dilation.
Limitations |
Single center, retrospective nature of study.
Conclusion |
For patients with refractory dysplasia or recurrent dysplasia after RFA, salvage cryotherapy is a safe and effective endoscopic therapy.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, HGD, LGD, RFA
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this article. |
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| See CME section; p. 557. |
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| If you would like to chat with an author of this article, you may contact Dr Sengupta at nsengup1@bidmc.harvard.edu. |
Vol 82 - N° 3
P. 443-448 - septembre 2015 Retour au numéro
Article précédent
- Ethics in publication
- Michael B. Wallace, Peter D. Siersema
- Cryoablation for managing Barrett’s esophagus refractory to radiofrequency ablation? Don’t embrace the cold too soon!
- Bas L.A.M. Weusten, Jacques J.G.H.M. Bergman
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