Radiofrequency ablation for low-grade dysplasia in Barrett's esophagus: long-term outcome of a randomized trial
Radiofrequency ablation for low-grade dysplasia in Barrett's esophagus: long-term outcome of a randomized trial
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DOI：
10.1016/j.gie.2020.03.3756
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发表时间：
2020-09-01
影响因子：
7.7
通讯作者：
Bergman, Jacques J.
中科院分区：
文献类型：
--
作者：
Pouw, Roos E.;Klaver, Esther;Bergman, Jacques J.
背景和目的：先前的一项随机研究(监视与射频消融研究[SURF研究])表明，射频消融(RFA)Barrett‘s食道(BE)合并低度异型增生(LGD)显著降低了食管腺癌的风险。我们的目的是报告这项研究的长期结果。方法：SURF研究随机将确诊的LGD患者接受RFA或监测。在这项回顾性队列研究中，收集了2013年5月至2017年12月SURF研究结束时获得的所有内窥镜和组织学数据。主要结果是进展到高度异型增生(HGD)/癌症的比率。SURF研究中随机接受RFA(n=68)或监测(n=68)的136名患者全部纳入。SURF研究结束后，15名监测患者根据患者的喜好和研究结果进行了RFA。结果：从随机到最后一次内窥镜检查，额外增加了40个月(四分位数范围12-51)，总的中位随访时间为73个月(四分位数范围46-85)。RFA组1例(1.5%)和监测组23例(33.8%)确诊HGD/癌症(P=.000)，绝对风险降低32.4%(95%可信区间，22.4%-44.2%)，需要治疗的人数为3.1(95%可信区间，2.3-4.5)。83例患者中75例(90%，95%可信区间，82.1%~95.0%)BE和异型增生完全清除。75例患者中7例复发(9%；95%可信区间，4.6%~18.0%)，多为细小岛状或舌状突起，3例复发(4%；95%可信区间1.4%~11.1%)。结论：经73个月的中位随访，BE合并LGD的RFA显著降低了恶性进展的风险，BE和LGD的持续清除率分别为91%和96%。
Background and Aims: A prior randomized study (Surveillance versus Radiofrequency Ablation study [SURF study]) demonstrated that radiofrequency ablation (RFA) of Barrett's esophagus (BE) with confirmed low-grade dysplasia (LGD) significantly reduces the risk of esophageal adenocarcinoma. Our aim was to report the long-term outcomes of this study.Methods: The SURF study randomized BE patients with confirmed LGD to RFA or surveillance. For this retrospective cohort study, all endoscopic and histologic data acquired at the end of the SURF study in May 2013 until December 2017 were collected. The primary outcome was rate of progression to high-grade dysplasia (HGD)/cancer. All 136 patients randomized to RFA (n = 68) or surveillance (n = 68) in the SURF study were included. After closure of the SURF study, 15 surveillance patients underwent RFA based on patient preference and study outcomes.Results: With 40 additional months (interquartile range, 12-51), the total median follow-up from randomization to last endoscopy was 73 months (interquartile range, 46-85). HGD/cancer was diagnosed in 1 patient in the RFA group (1.5%) and in 23 in the surveillance group (33.8%) (P = .000), resulting in an absolute risk reduction of 32.4% (95% confidence interval [CI], 22.4%-44.2%) with a number needed to treat of 3.1 (95% CI, 2.3-4.5). Seventy-five of 83 patients (90%; 95% CI, 82.1%-95.0%) treated with RFA for BE reached complete clearance of BE and dysplasia. BE recurred in 7 of 75 patients (9%; 95% CI, 4.6%-18.0%), mostly minute islands or tongues, and LGD in 3 of 75 (4%; 95% CI, 1.4%-11.1%).Conclusions: RFA of BE with confirmed LGD significantly reduces the risk of malignant progression, with sustained clearance of BE in 91% and LGD in 96% of patients, after a median follow-up of 73 months.