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Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.

Ganz, Robert A; Overholt, Bergein F; Sharma, Virender K; Fleischer, David E; Shaheen, Nicholas J; Lightdale, Charles J; Freeman, Stephen R; Pruitt, Ronald E; Urayama, Shiro M; Gress, Frank; Pavey, Darren A; Branch, M Stanley; Savides, Thomas J; Chang, Kenneth J; Muthusamy, V Raman; Bohorfoush, Anthony G; Pace, Samuel C; DeMeester, Steven R; Eysselein, Viktor E; Panjehpour, Masoud; Triadafilopoulos, George.
Gastrointest Endosc; 68(1): 35-40, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18355819

BACKGROUND:

The management strategies for Barrett's esophagus (BE) that contains high-grade dysplasia (HGD) include intensive endoscopic surveillance, photodynamic therapy, thermal ablation, EMR, and esophagectomy.

OBJECTIVE:

To assess the safety and effectiveness of endoscopic circumferential balloon-based ablation by using radiofrequency energy for treating BE HGD.

DESIGN:

Multicenter U.S. registry.SETTING: Sixteen academic and community centers; treatment period from September 2004 to March 2007.PATIENTS: Patients with histologic evidence of intestinal metaplasia (IM) that contained HGD confirmed by at least 2 expert pathologists. A prior EMR was permitted, provided that residual HGD remained in the BE region for ablation.INTERVENTION: Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment.

OUTCOMES:

Histologic complete response (CR) end points: (1) all biopsy specimen fragments obtained at the last biopsy session were negative for HGD (CR-HGD), (2) all biopsy specimens were negative for any dysplasia (CR-D), and (3) all biopsy specimens were negative for IM (CR-IM).

RESULTS:

A total of 142 patients (median age 66 years, interquartile range [IQR] 59-75 years) who had BE HGD (median length 6 cm, IQR 3-8 cm) underwent circumferential ablation (median 1 session, IQR 1-2). No serious adverse events were reported. There was 1 asymptomatic stricture and no buried glands. Ninety-two patients had at least 1 follow-up biopsy session (median follow-up 12 months, IQR 8-15 months). A CR-HGD was achieved in 90.2% of patients, CR-D in 80.4%, and CR-IM in 54.3%.

LIMITATIONS:

A nonrandomized study design, without a control arm, a lack of centralized pathology review, ablation and biopsy technique not standardized, and a relatively short-term follow-up.

CONCLUSIONS:

Endoscopic circumferential ablation is a promising modality for the treatment of BE that contains HGD. In this multicenter registry, the intervention safely achieved a CR for HGD in 90.2% of patients at a median of 12 months of follow-up.
Selo DaSilva