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Durability of radiofrequency ablation in Barrett's esophagus with dysplasia.

Shaheen, Nicholas J; Overholt, Bergein F; Sampliner, Richard E; Wolfsen, Herbert C; Wang, Kenneth K; Fleischer, David E; Sharma, Virender K; Eisen, Glenn M; Fennerty, M Brian; Hunter, John G; Bronner, Mary P; Goldblum, John R; Bennett, Ana E; Mashimo, Hiroshi; Rothstein, Richard I; Gordon, Stuart R; Edmundowicz, Steven A; Madanick, Ryan D; Peery, Anne F; Muthusamy, V Raman; Chang, Kenneth J; Kimmey, Michael B; Spechler, Stuart J; Siddiqui, Ali A; Souza, Rhonda F; Infantolino, Anthony; Dumot, John A; Falk, Gary W; Galanko, Joseph A; Jobe, Blair A; Hawes, Robert H; Hoffman, Brenda J; Sharma, Prateek; Chak, Amitabh; Lightdale, Charles J.
Gastroenterology; 141(2): 460-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21679712
BACKGROUND & AIMS: Radiofrequency ablation (RFA) can eradicate dysplasia and intestinal metaplasia in patients with dysplastic Barrett's esophagus (BE), and reduce rates of esophageal adenocarcinoma. We assessed long-term rates of eradication, durability of neosquamous epithelium, disease progression, and safety of RFA in patients with dysplastic BE.

METHODS:

We performed a randomized trial of 127 subjects with dysplastic BE; after cross-over subjects were included, 119 received RFA. Subjects were followed for a mean time of 3.05 years; the study was extended to 5 years for patients with eradication of intestinal metaplasia at 2 years. Outcomes included eradication of dysplasia or intestinal metaplasia after 2 and 3 years, durability of response, disease progression, and adverse events.

RESULTS:

After 2 years, 101 of 106 patients had complete eradication of all dysplasia (95%) and 99 of 106 had eradication of intestinal metaplasia (93%). After 2 years, among subjects with initial low-grade dysplasia, all dysplasia was eradicated in 51 of 52 (98%) and intestinal metaplasia was eradicated in 51 of 52 (98%); among subjects with initial high-grade dysplasia, all dysplasia was eradicated in 50 of 54 (93%) and intestinal metaplasia was eradicated in 48 of 54 (89%). After 3 years, dysplasia was eradicated in 55 of 56 of subjects (98%) and intestinal metaplasia was eradicated in 51 of 56 (91%). Kaplan-Meier analysis showed that dysplasia remained eradicated in >85% of patients and intestinal metaplasia in >75%, without maintenance RFA. Serious adverse events occurred in 4 of 119 subjects (3.4%); the rate of stricture was 7.6%. The rate of esophageal adenocarcinoma was 1 per 181 patient-years (0.55%/patient-years); there was no cancer-related morbidity or mortality. The annual rate of any neoplastic progression was 1 per 73 patient-years (1.37%/patient-years).

CONCLUSIONS:

In subjects with dysplastic BE, RFA therapy has an acceptable safety profile, is durable, and is associated with a low rate of disease progression, for up to 3 years.
Selo DaSilva