BACKGROUND AND STUDY AIMS: Stepwise circumferential and focal ablation of nondysplastic Barrett's esophagus has proven safe and effective. This study assessed the efficacy and safety of ablation for Barrett's esophagus with high-grade dysplasia (HGD), and residual Barrett's esophagus with dysplasia after prior endoscopic resection for visible lesions. PATIENTS AND METHODS: This was a prospective cohort study. All visible abnormalities were resected prior to ablation. Persistence of dysplasia and absence of invasive cancer was confirmed with biopsies after endoscopic resection. A balloon-based electrode was used for primary circumferential ablation and an endoscope-mounted electrode was used for secondary focal ablation. Eradication of dysplasia and Barrett's esophagus was the main outcome measure. RESULTS: Eleven patients (eight men; median age 60 years) were treated (median Barrett's length 5 cm). Visible abnormalities were removed with endoscopic resection in six patients. The worst pathological grade of residual Barrett's esophagus after endoscopic resection and prior to ablation was LGD (n = 2) and HGD (n = 9). Patients underwent a median of two circumferential and two focal ablation sessions. Complete remission of dysplasia and complete endoscopic and histological removal of Barrett's esophagus was achieved in 11/11 patients (100%). There were no adverse events or strictures, and in none of the 473 biopsies of neo-squamous mucosa was subsquamous Barrett's esophagus ("buried Barrett's") observed. During a median follow-up period of 14 months after the last treatment session and a median number of two follow-up endoscopies, none of the patients showed recurrence of dysplasia or endoscopic signs of recurrent Barrett's mucosa. CONCLUSIONS: Stepwise circumferential and focal ablation appears to be a safe and effective treatment for complete removal of Barrett's esophagus containing HGD, and can be safely performed after prior endoscopic resection for endoscopically visible abnormalities.
BACKGROUND AND STUDY AIMS: Stepwise circumferential and focal ablation of nondysplastic Barrett's esophagus has proven safe and effective. This study assessed the efficacy and safety of ablation for Barrett's esophagus with high-grade dysplasia (HGD), and residual Barrett's esophagus with dysplasia after prior endoscopic resection for visible lesions. PATIENTS AND METHODS: This was a prospective cohort study. All visible abnormalities were resected prior to ablation. Persistence of dysplasia and absence of invasive cancer was confirmed with biopsies after endoscopic resection. A balloon-based electrode was used for primary circumferential ablation and an endoscope-mounted electrode was used for secondary focal ablation. Eradication of dysplasia and Barrett's esophagus was the main outcome measure. RESULTS: Eleven patients (eight men; median age 60 years) were treated (median Barrett's length 5 cm). Visible abnormalities were removed with endoscopic resection in six patients. The worst pathological grade of residual Barrett's esophagus after endoscopic resection and prior to ablation was LGD (n = 2) and HGD (n = 9). Patients underwent a median of two circumferential and two focal ablation sessions. Complete remission of dysplasia and complete endoscopic and histological removal of Barrett's esophagus was achieved in 11/11 patients (100%). There were no adverse events or strictures, and in none of the 473 biopsies of neo-squamous mucosa was subsquamous Barrett's esophagus ("buried Barrett's") observed. During a median follow-up period of 14 months after the last treatment session and a median number of two follow-up endoscopies, none of the patients showed recurrence of dysplasia or endoscopic signs of recurrent Barrett's mucosa. CONCLUSIONS: Stepwise circumferential and focal ablation appears to be a safe and effective treatment for complete removal of Barrett's esophagus containing HGD, and can be safely performed after prior endoscopic resection for endoscopically visible abnormalities.
Authors: Chin Hur; Sung Eun Choi; Joel H Rubenstein; Chung Yin Kong; Norman S Nishioka; Dawn T Provenzale; John M Inadomi Journal: Gastroenterology Date: 2012-05-21 Impact factor: 22.682
Authors: Hannah P Kim; William J Bulsiewicz; Cary C Cotton; Evan S Dellon; Melissa B Spacek; Xiaoxin Chen; Ryan D Madanick; Sarina Pasricha; Nicholas J Shaheen Journal: Gastrointest Endosc Date: 2012-06-23 Impact factor: 9.427
Authors: Bruce D Greenwald; Charles J Lightdale; Julian A Abrams; John D Horwhat; Ram Chuttani; Srinadh Komanduri; Melissa P Upton; Henry D Appelman; Helen M Shields; Nicholas J Shaheen; Stephen J Sontag Journal: Ann N Y Acad Sci Date: 2011-09 Impact factor: 5.691
Authors: Cathy Bennett; Nimish Vakil; Jacques Bergman; Rebecca Harrison; Robert Odze; Michael Vieth; Scott Sanders; Laura Gay; Oliver Pech; Gaius Longcroft-Wheaton; Yvonne Romero; John Inadomi; Jan Tack; Douglas A Corley; Hendrik Manner; Susi Green; David Al Dulaimi; Haythem Ali; Bill Allum; Mark Anderson; Howard Curtis; Gary Falk; M Brian Fennerty; Grant Fullarton; Kausilia Krishnadath; Stephen J Meltzer; David Armstrong; Robert Ganz; Gianpaolo Cengia; James J Going; John Goldblum; Charles Gordon; Heike Grabsch; Chris Haigh; Michio Hongo; David Johnston; Ricky Forbes-Young; Elaine Kay; Philip Kaye; Toni Lerut; Laurence B Lovat; Lars Lundell; Philip Mairs; Tadakuza Shimoda; Stuart Spechler; Stephen Sontag; Peter Malfertheiner; Iain Murray; Manoj Nanji; David Poller; Krish Ragunath; Jaroslaw Regula; Renzo Cestari; Neil Shepherd; Rajvinder Singh; Hubert J Stein; Nicholas J Talley; Jean-Paul Galmiche; Tony C K Tham; Peter Watson; Lisa Yerian; Massimo Rugge; Thomas W Rice; John Hart; Stuart Gittens; David Hewin; Juergen Hochberger; Peter Kahrilas; Sean Preston; Richard Sampliner; Prateek Sharma; Robert Stuart; Kenneth Wang; Irving Waxman; Chris Abley; Duncan Loft; Ian Penman; Nicholas J Shaheen; Amitabh Chak; Gareth Davies; Lorna Dunn; Yngve Falck-Ytter; John Decaestecker; Pradeep Bhandari; Christian Ell; S Michael Griffin; Stephen Attwood; Hugh Barr; John Allen; Mark K Ferguson; Paul Moayyedi; Janusz A Z Jankowski Journal: Gastroenterology Date: 2012-04-24 Impact factor: 22.682
Authors: Nicholas J Shaheen; Bergein F Overholt; Richard E Sampliner; Herbert C Wolfsen; Kenneth K Wang; David E Fleischer; Virender K Sharma; Glenn M Eisen; M Brian Fennerty; John G Hunter; Mary P Bronner; John R Goldblum; Ana E Bennett; Hiroshi Mashimo; Richard I Rothstein; Stuart R Gordon; Steven A Edmundowicz; Ryan D Madanick; Anne F Peery; V Raman Muthusamy; Kenneth J Chang; Michael B Kimmey; Stuart J Spechler; Ali A Siddiqui; Rhonda F Souza; Anthony Infantolino; John A Dumot; Gary W Falk; Joseph A Galanko; Blair A Jobe; Robert H Hawes; Brenda J Hoffman; Prateek Sharma; Amitabh Chak; Charles J Lightdale Journal: Gastroenterology Date: 2011-05-06 Impact factor: 22.682
Authors: Milli Gupta; Prasad G Iyer; Lori Lutzke; Emmanuel C Gorospe; Julian A Abrams; Gary W Falk; Gregory G Ginsberg; Anil K Rustgi; Charles J Lightdale; Timothy C Wang; David I Fudman; John M Poneros; Kenneth K Wang Journal: Gastroenterology Date: 2013-03-15 Impact factor: 22.682
Authors: Eric S Orman; Hannah P Kim; William J Bulsiewicz; Cary C Cotton; Evan S Dellon; Melissa B Spacek; Xiaoxin Chen; Ryan D Madanick; Sarina Pasricha; Nicholas J Shaheen Journal: Am J Gastroenterol Date: 2012-12-18 Impact factor: 10.864