TY - JOUR
T1 - Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 10 cm
AU - Alvarez Herrero, Lorenza
AU - van Vilsteren, Frederike G I
AU - Pouw, Roos E
AU - ten Kate, Fiebo J W
AU - Visser, Mike
AU - Seldenrijk, Cornelis A
AU - van Berge Henegouwen, Mark I
AU - Fockens, Paul
AU - Weusten, Bas L A M
AU - Bergman, Jaques J G H M
N1 - Funding Information: 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.
PY - 2011/4
Y1 - 2011/4
N2 - Background: Radiofrequency ablation (REA) is safe and effective for eradicating Barrett's esophagus (BE) and BE-associated early neoplasia. Most REA studies have limited the baseline length of BE ( <10 cm), and therefore little is known about REA for longer BE. Objective: To assess the safety and efficacy of RFA with or without prior endoscopic resection (ER) for BE >= 10 ern 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 REA 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. (Gastrointest Endosc 2011;73:682-90.)
AB - Background: Radiofrequency ablation (REA) is safe and effective for eradicating Barrett's esophagus (BE) and BE-associated early neoplasia. Most REA studies have limited the baseline length of BE ( <10 cm), and therefore little is known about REA for longer BE. Objective: To assess the safety and efficacy of RFA with or without prior endoscopic resection (ER) for BE >= 10 ern 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 REA 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. (Gastrointest Endosc 2011;73:682-90.)
KW - APC
KW - BE
KW - Barrett's esophagus
KW - CI
KW - CR-IM
KW - CR-neoplasia
KW - EC
KW - ER
KW - HGIN
KW - IM
KW - IQR
KW - LGIN
KW - RFA
KW - argon plasma coagulation
KW - complete removal of intestinal metaplasia
KW - complete removal of neoplasia
KW - confidence interval
KW - early cancer
KW - endoscopic resection
KW - high-grade intraepithelial neoplasia
KW - interquartile range
KW - intestinal metaplasia
KW - low-grade intraepithelial neoplasia
KW - radiofrequency ablation
UR - http://www.scopus.com/inward/record.url?scp=79953242143&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.gie.2010.11.016
DO - https://doi.org/10.1016/j.gie.2010.11.016
M3 - Article
C2 - 21292262
SN - 0016-5107
VL - 73
SP - 682
EP - 690
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 4
ER -