Comparative outcomes of radiofrequency ablation and cryoballoon ablation in dysplastic Barrett's esophagus: a propensity score-matched cohort study
Comparative outcomes of radiofrequency ablation and cryoballoon ablation in dysplastic Barrett's esophagus: a propensity score-matched cohort study
复制标题
DOI：
10.1016/j.gie.2021.09.037
复制
发表时间：
2022-02-15
影响因子：
7.7
通讯作者：
Iyer, Prasad G.
中科院分区：
文献类型：
--
作者：
Agarwal, Siddharth;Alshelleh, Mohammad;Iyer, Prasad G.
背景和目标：强有力的证据支持使用射频消融（RFA）治疗异型增生/肿瘤性Barrett食管（BE）。最近，在多中心队列研究中证实了冷冻球囊消融（CBA）系统的有效性。我们的目的是评估比较有效性和安全性，这2个消融方式的内镜下根除治疗（EET）在队列study.Methods：数据被抽象的异型增生BE或粘膜内癌患者接受EET使用RFA或CBA作为主要消融方式在2个转诊中心。主要结局是肠上皮化生完全缓解率（CRIM）。次要结局是异型增生完全缓解（CRD）率和不良事件。考克斯比例风险模型和倾向评分匹配分析进行了比较outcomes.Results：311例患者（CBA，85例患者; RFA，226例患者），RFA组中位随访时间为1.5年（四分位距，0.8，2.5），CBA组中位随访时间为2.0年（四分位距，1.3，2.5）。在多变量分析中，达到CRD和CRIM的机会不受消融方式的影响。倾向评分匹配分析显示，实现CRIM（CBA vs RFA：风险比，1.24; 95%置信区间，0.79 -1.96; P = 0.35）和CRD（CBA vs RFA：风险比，1.19; 95%置信区间，0.82 -1.73; P = 0.36）的机会相当。CBA组的狭窄率高于RFA组（10.4% vs 4.4%，P = 0.04）。结论：使用CBA和RFA治疗异型增生BE的EET的组织学结局似乎相当。需要一项随机试验来明确比较这两种方式之间的结果。
Background and Aims: Strong evidence supports the use of radiofrequency ablation (RFA) in the management of dysplastic/neoplastic Barrett's esophagus (BE). Recently, the efficacy of the cryoballoon ablation (CBA) system was demonstrated in multicenter cohort studies. We aimed to assess the comparative effectiveness and safety of these 2 ablation modalities for endoscopic eradication therapy (EET) in a cohort study.Methods: Data were abstracted on patients with dysplastic BE or intramucosal carcinoma undergoing EET using RFA or CBA as the primary ablation modality at 2 referral centers. The primary outcome was the rate of complete remission intestinal metaplasia (CRIM). Secondary outcomes were rates of complete remission of dysplasia (CRD) and adverse events. Cox proportional hazards models and propensity scored-matched analyses were conducted to compare outcomes.Results: Three hundred eleven patients (CBA, 85 patients; RFA, 226 patients) with a median follow-up of 1.5 years (interquartile range, .8, 2.5) in the RFA group and 2.0 years (interquartile range, 1.3, 2.5) in theCBA group were studied. On multivariable analyses, the chances of reaching CRD and CRIM were not influenced by ablation modality. Propensity score-matched analysis revealed a comparable chance of achieving CRIM (CBA vs RFA: hazard ratio, 1.24; 95% confidence interval, .79-1.96; P = .35) and CRD(CBA vs RFA: hazard ratio, 1.19; 95% confidence interval, .82-1.73; P = .36). The CBA group had a higher stricture rate compared with the RFA group (10.4% vs 4.4%, P = .04).Conclusions: Histologic outcomes of EET using CBA and RFA for dysplastic BE appear to be comparable. A randomized trial is needed to definitively compare outcomes between these 2 modalities.