Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett's esophagus
Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett's esophagus
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DOI：
10.1055/s-0034-1391734
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发表时间：
2015-07-01
期刊：
影响因子：
9.3
通讯作者：
Pasricha, Pankaj
中科院分区：
文献类型：
--
作者：
Canto, Marcia Irene;Shin, Eun Ji;Pasricha, Pankaj
背景和研究目的：内镜冷冻治疗已成功用于Barrett食管消融，但结果数据有限。本研究的目的是评估长期的安全性和有效性的二氧化碳（CO2）冷冻治疗的初级或抢救治疗巴雷特食管与高度异型增生（HGD）或neoplasia.Patients和方法：这是一个回顾性的，单中心，非随机研究进行了学术，三级保健中心和附属社区医院。共入组了78例既往未接受消融术（未接受过治疗组）或既往接受过治疗但仍有持续性或复发性肿瘤形成（补救治疗组）的肿瘤性Barrett食管患者。如果存在可见的Barrett病变，则通过内镜粘膜切除术去除，然后进行CO2冷冻治疗，直至肿瘤根除，或需要介入治疗，或认为治疗失败。以标准间隔进行监测活检。计算癌症、HGD和肠上皮化生的完全缓解率。治疗失败，复发，不良事件，进展和死亡率也recorded.Results：在2006年和2013年之间，64个可评估的患者（20治疗初治，44补救治疗）进行了治疗和随访（中位时间4.2年）。1年时，癌症的总体完全缓解率为77%（10/13），异型增生为89%（57/64），HGD为94%（60/64;初治为100%，补救治疗为91%），肠上皮化生为55%（35/64）。肿瘤补救治疗的长期完全缓解率为87%（56/64）。疾病特异性死亡率为1/68（2%）。治疗未能根除4名患者（6%）的肿瘤（均在补救组）。在两次阴性随访程序后，在20/64（31%）中检测到复发或新发肠上皮化生。在2例患者中观察到严重不良事件（3%）。4名患者发生冷冻治疗后疼痛（6%;仅2名患者需要止痛药）。未观察到出血或新发狭窄。在5/68例患者（7%）中检测到埋藏Barrett's。结论：CO2冷冻治疗是Barrett's瘤形成的一种安全有效的主要治愈或挽救治疗。
Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of Barrett's esophagus but outcome data are limited. The aim of this study was to assess the long-term safety and efficacy of carbon dioxide (CO2) cryotherapy as primary or rescue treatment for Barrett's esophagus with high grade dysplasia (HGD) or neoplasia.Patients and methods: This was a retrospective, single-center, nonrandomized study carried out in an academic, tertiary care center and affiliated community hospital. A total of 78 patients with neoplastic Barrett's esophagus who had not undergone previous ablation (treatment-naive group) or who had persistent or recurrent neoplasia despite previous treatment (rescue treatment group) were enrolled. Visible Barrett's lesions, when present, were removed by endoscopic mucosal resection, which was followed by CO2 cryotherapy until neoplasia had been eradicated, or intervening therapy was necessary, or treatment was considered to have failed. Surveillance biopsies were obtained at standard intervals. Rates of complete response for cancer, HGD, and intestinal metaplasia were calculated. Treatment failure, recurrence, adverse events, progression, and mortality were also recorded.Results: Between 2006 and 2013, 64 evaluable patients (20 treatment naive, 44 rescue treatment) were treated and followed up (median time 4.2 years). At 1 year, the overall complete response rates were 77% for cancer (10/13), 89% for dysplasia 57/64), 94% for HGD (60/64; 100% for treatment naive, 91% for rescue treatment), and 55% for intestinal metaplasia (35/64). Long-term complete response for neoplasiawith rescue therapy was 87% (56/64). Disease-specific mortality was 1/68 (2 %). Treatment failed to eradicate neoplasia in four patients (6 %) (all in the rescue group). Recurrent or new intestinal metaplasia was detected in 20/64 (31 %) after two negative follow-up procedures. Serious adverse events were noted in two patients (3 %). Post-cryotherapy pain occurred in four patients (6 %; only two needed analgesics). No bleeding or new strictures were noted. Buried Barrett's was detected in 5/68 patients (7 %).Conclusions: CO2 cryotherapy was a safe and effective primary curative or rescue therapy for Barrett's neoplasia.