Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia - 17/09/12
Reprint requests: Nicholas Shaheen, MD, MPH, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., UNC-CH, Chapel Hill, NC 27599-7080Riassunto |
Background |
EMR is commonly performed before radiofrequency ablation (RFA) for nodular dysplastic Barrett's esophagus (BE).
Objective |
To determine the efficacy and safety of EMR before RFA for nodular BE with advanced neoplasia (high-grade dysplasia [HGD] or intramucosal carcinoma [IMC]).
Design |
Retrospective study.
Setting |
University of North Carolina Hospitals, from 2006 to 2011.
Patients |
169 patients with BE with advanced neoplasia: 65 patients treated with EMR and RFA for nodular disease and 104 patients treated with RFA alone for nonnodular disease.
Interventions |
EMR, RFA.
Main Outcome Measurements |
Efficacy (complete eradication of dysplasia, complete eradication of intestinal metaplasia, total treatment sessions, RFA treatment sessions), safety (stricture formation, bleeding, and hospitalization).
Results |
EMR followed by RFA achieved complete eradication of dysplasia and complete eradication of intestinal metaplasia in 94.0% and 88.0% of patients, respectively, compared with 82.7% and 77.6% of patients, respectively, in the RFA-only group (P = .06 and P = .13, respectively). The complication rates between the 2 groups were similar (7.7% vs 9.6%, P = .79). Strictures occurred in 4.6% of patients in the EMR-before-RFA group. compared with 7.7% of patients in the RFA-only group (P = .53).
Limitations |
Retrospective study at a tertiary-care referral center.
Conclusion |
In patients treated with EMR before RFA for nodular BE with HGD or IMC, no differences in efficacy and safety outcomes were observed compared with RFA alone for nonnodular BE with HGD or IMC. EMR followed by RFA is safe and effective for patients with nodular BE and advanced neoplasia.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : BE, CED, CEIM, HGD, IMC, ITT, PP, RFA
Mappa
| DISCLOSURE: The following authors received research support for this study: N. J. Shaheen from BARRX Medical and CSA Medical; X. Chen from Takeda Pharmaceuticals North America, Inc. All other authors disclosed no financial relationships relevant to this publication. Research support was provided by a grant from the Doris Duke Charitable Foundation to the University of North Carolina-Chapel Hill (HPK), NIH P30 DK034987 (W.J.B., E.S.D., N.J.S.), and NIH T32 DK007634 (W.J.B.). |
Vol 76 - N° 4
P. 733-739 - ottobre 2012 Ritorno al numero
Articolo precedente
- Joseph Barnett Kirsner, MD, PhD
- Stephen B. Hanauer, David Rubin
- Comparing apples with apples and oranges: the role of radiofrequency ablation alone versus radiofrequency ablation plus EMR for endoscopic management of Barrett's esophagus with advanced neoplasia
- David E. Fleischer
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