Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a US multicenter registry
Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a US multicenter registry
复制标题
DOI：
10.1016/j.gie.2007.12.015
复制
发表时间：
2008-07-01
影响因子：
7.7
通讯作者：
Triadafilopoulos, George
中科院分区：
文献类型：
--
作者：
Ganz, Robert A.;Overholt, Bergein F.;Triadafilopoulos, George
背景：Barrett‘s Eagagus(BE)合并重度异型增生(HGD)的治疗策略包括强化内窥镜监视、光动力治疗、热消融、EMR和食道切除术。目的：评价经内窥镜下基于球囊的射频消融治疗BE HGD的安全性和有效性。设计：美国多中心注册。设置：16个学术和社区中心；治疗时间从2004年9月至2007年3月。患者：经至少2名专家病理学家证实的肠化生(IM)的组织学证据。结果：组织学完全反应(CR)终点：(1)上一次活检获得的所有活检标本片段均为阴性(CR-HGD)，(2)所有活检标本均为阴性(CR-D)，(3)所有活检标本均为IM(CR-IM)阴性。结果：共142例患者(中位年龄66岁，四分位数范围[IQR]59-75岁)的患者(中位数长度6 cm，IQR 3-8 cm)接受了环切(中位数1次，IQR 1-2次)。没有严重不良反应的报道。无症状性狭窄1例，无腺体埋藏。92例患者至少有1次随访活检(平均随访12个月，IQR8-15个月)。CR-HGD的成功率为90.2%，CR-D为80.4%，CR-IM为54.3%。限制：非随机研究设计，无对照臂，缺乏集中的病理回顾，消融和活检技术不规范，随访时间相对较短。结论：内窥镜下环向消融术是治疗含HGD的BE的一种有前景的方法。在这项多中心登记中，在中位数为12个月的随访中，90.2%的患者安全地获得了HGD的CR。
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 esophagectorry.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.