Abstract
Combined endoscopic treatment using endoscopic resection (ER) and radiofrequency ablation (RFA) for early Barrett’s neoplasia (i.e, low-grade dysplasia (LGD), high-grade dysplasia (HGD) or early carcinoma without any histopathological risk factors for lymph node metastasis) is a proven safe and effective treatment method. Now, the goal is to work towards personalized patient care. In this thesis, we therefore evaluated whether the current methods of endoscopic management could be optimized.
94% of patients accomplish complete eradication of Barrett’s epithelium with endoscopic combination therapy. Only 3% of patients develop recurrent neoplasia, and only 0.4% evolve into high-stage cancer. We concluded that surveillance intervals could be widened after accomplishing complete eradication in expert centers. Also, three monthly endoscopies in the first year after treatment and random biopsies from neosquamous epithelium and cardia seem unnecessary. Careful endoscopic inspection is the most important to discover recurrent neoplasia during follow-up. Different variables seem independently associated with recurrence (“incident” lesion during treatment phase, higher number of ER treatments, male gender, longer Barrett, HGD or cancer at baseline, younger age). Our externally validated prediction model could help to manage expectations of treatment and choosing a personalized surveillance approach.
Furthermore, we evaluated whether endoscopic management could be safe for early cancer with histopathological risk factors for metastasis (≥sm1, lymphovascular invasion, poor differentiation). We differentiated between 3 patient groups: intramucosal with histopathological risk factors (T1a-HR), submucosal without other histopathological risk factors (T1b-LR) and submucosal with other histopathological risk factors (T1b-HR). Metastases were found in 5/25 patients (yearly risk 6.9%), 1/55 patients (0.7%) and 3/40 patients (3.0%) in T1a-HR, T1b-LR, T1b-HR, respectively. Endoscopic management could be an option in specific patients. However, prospective data is needed to further assess the safety.
94% of patients accomplish complete eradication of Barrett’s epithelium with endoscopic combination therapy. Only 3% of patients develop recurrent neoplasia, and only 0.4% evolve into high-stage cancer. We concluded that surveillance intervals could be widened after accomplishing complete eradication in expert centers. Also, three monthly endoscopies in the first year after treatment and random biopsies from neosquamous epithelium and cardia seem unnecessary. Careful endoscopic inspection is the most important to discover recurrent neoplasia during follow-up. Different variables seem independently associated with recurrence (“incident” lesion during treatment phase, higher number of ER treatments, male gender, longer Barrett, HGD or cancer at baseline, younger age). Our externally validated prediction model could help to manage expectations of treatment and choosing a personalized surveillance approach.
Furthermore, we evaluated whether endoscopic management could be safe for early cancer with histopathological risk factors for metastasis (≥sm1, lymphovascular invasion, poor differentiation). We differentiated between 3 patient groups: intramucosal with histopathological risk factors (T1a-HR), submucosal without other histopathological risk factors (T1b-LR) and submucosal with other histopathological risk factors (T1b-HR). Metastases were found in 5/25 patients (yearly risk 6.9%), 1/55 patients (0.7%) and 3/40 patients (3.0%) in T1a-HR, T1b-LR, T1b-HR, respectively. Endoscopic management could be an option in specific patients. However, prospective data is needed to further assess the safety.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Award date | 9 Dec 2022 |
| Print ISBNs | 9789464196030 |
| Publication status | Published - 2022 |
