Radiofrequency ablation for early oesophageal squamous neoplasia: Outcomes form United Kingdom registry
Radiofrequency ablation for early oesophageal squamous neoplasia: Outcomes form United Kingdom registry
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DOI：
10.3748/wjg.v19.i36.6011
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发表时间：
2013-09-28
影响因子：
4.3
通讯作者：
Lovat, Laurence B.
中科院分区：
文献类型：
--
作者：
Haidry, Rehan J.;Butt, Mohammed A.;Lovat, Laurence B.
目的：报告国家登记处接受射频消融（RFA）治疗早期食管鳞状上皮瘤变的患者的结局。方法：来自英国8个三级转诊中心的前瞻性队列研究。治疗局限于粘膜的鳞状高度异型增生（HGD）和早期鳞状细胞癌（ESCC）患者。在RFA前通过内镜粘膜切除术（EMR）切除可见病变。初次RFA治疗后，患者随访3个月。使用RFA治疗残留的扁平异型增生，直至达到完全逆转异型增生（CR-D）或进展为浸润性鳞状细胞癌（定义为浸润至粘膜下层或更深）。主要的结果措施是CR-D在12个月从治疗开始，长期的耐久性，进展到癌症和不良事件。5例患者（25%）在开始RFA治疗前发生EMR。12个月时CR-D为50%，中位1次RFA治疗，平均1.5（范围1-3）。此后，另外2例患者通过重复RFA达到CR-D。80%的CR-D患者在最近一次活检时保持无异型增生，中位随访时间为24个月（IQR 17-54）。20例患者中有6例（30%）在1年时进展为浸润性癌症。4例患者（20%）在治疗后因症状性结构需要内镜检查。其中2例患者此后因症状性吞咽困难需要进行系列吞咽，每例患者的中位吞咽次数为4次。另外2例患者仅需单次扩张即可达到充分的症状缓解。1例患者在治疗方案结束后随访期间发生癌症。结论：RFA在这些患者中的作用尚不清楚。在我们的系列中，50%的患者在12个月时有反应。这些数字低于有限的公布数据。(C)2013年百世登。All rights reserved.
AIM: To report outcomes on patients undergoing radiofrequency ablation (RFA) for early oesophageal squamous neoplasia from a National Registry.METHODS: A Prospective cohort study from 8 tertiary referral centres in the United Kingdom. Patients with squamous high grade dysplasia (HGD) and early squamous cell carcinoma (ESCC) confined to the mucosa were treated. Visible lesions were removed by endoscopic mucosal resection (EMR) before RFA. Following initial RFA treatment, patients were followed up 3 monthly. Residual flat dysplasia was treated with RFA until complete reversal dysplasia (CR-D) was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond. The main outcome measures were CR-D at 12 mo from start of treatment, long term durability, progression to cancer and adverse events.RESULTS: Twenty patients with squamous HGD/ESCC completed treatment protocol. Five patients (25%) had EMR before starting RFA treatment. CR-D was 50% at 12 mo with a median of 1 RFA treatment, mean 1.5 (range 1-3). Two further patients achieved CR-D with repeat RFA after this time. Eighty per cent with CR-D remain dysplasia free at latest biopsy, with median follow up 24 mo (IQR 17-54). Six of 20 patients (30%) progressed to invasive cancer at 1 year. Four patients (20%) required endoscopic dilatations for symptomatic structuring after treatment. Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient. The other 2 patients required only a single dilatation to achieve an adequate symptomatic response. One patient developed cancer during follow up after end of treatment protocol.CONCLUSION: The role of RFA in these patients remains unclear. In our series 50% patients responded at 12 mo. These figures are lower than limited published data. (C) 2013 Baishideng. All rights reserved.