Hendrik Manner1, Andrea May2, Ioanna Kouti3, Oliver Pech4, Michael Vieth5, Christian Ell2. 1. Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany. HSManner@gmx.de. 2. Department of Internal Medicine, Sana Klinikum, Offenbach, Germany. 3. Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany. 4. Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany. 5. Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany.
Abstract
BACKGROUND AND STUDY AIM: After thermal ablation of Barrett's esophagus (BE), stricture formation is reported in 5 to over 10% of patients. The question arises whether submucosal fluid injection prior to ablation may lower the risk of stricture formation. The aim of the present study was to evaluate the efficacy and safety of the new technique of Hybrid-APC which combines submucosal injection with APC. PATIENTS AND METHODS: Patients who had a residual BE segment of at least 1 cm after endoscopic resection of early Barrett's neoplasia underwent thermal ablation of BE by Hybrid-APC. Prior to thermal ablation, submucosal injection of sodium chloride 0.9% was carried out using a flexible water-jet probe (Erbejet 2; Erbe Elektromedizin, Tuebingen, Germany). Check-up upper GI endoscopy was carried out 3 months after macroscopically complete ablation including biopsies from the neo-Z-line and the former BE segment, and recording of stricture formation. RESULTS: From May 2011 to November 2012, a total of 60 patients (pt) were included in the study [55 pt male (92%); mean age 62 ± 9 years, range 42-79]. Ten patients were excluded from the study. In the remaining 50 pt, Hybrid-APC ablation and check-up endoscopy at 3 months were carried out. Forty-eight out of 50 pt (96%; ITT: 49/60, 82%) achieved macroscopically complete remission after a median of 3.5 APC sessions [SD 2.4; range 1-10]. Freedom from BE was histopathologically observed in 39/50 patients (78%). There was one treatment-related stricture (2%). Minor adverse events of Hybrid-APC were observed in 11 patients (22%). CONCLUSIONS: According to this pilot series, Hybrid-APC was effective and safe for BE ablation in a tertiary referral center. The rate of stricture formation was only 2%. Further studies are required to confirm the present results. GERMAN CLINICAL TRIALS REGISTER: DRKS00003369.
BACKGROUND AND STUDY AIM: After thermal ablation of Barrett's esophagus (BE), stricture formation is reported in 5 to over 10% of patients. The question arises whether submucosal fluid injection prior to ablation may lower the risk of stricture formation. The aim of the present study was to evaluate the efficacy and safety of the new technique of Hybrid-APC which combines submucosal injection with APC. PATIENTS AND METHODS: Patients who had a residual BE segment of at least 1 cm after endoscopic resection of early Barrett's neoplasia underwent thermal ablation of BE by Hybrid-APC. Prior to thermal ablation, submucosal injection of sodium chloride 0.9% was carried out using a flexible water-jet probe (Erbejet 2; Erbe Elektromedizin, Tuebingen, Germany). Check-up upper GI endoscopy was carried out 3 months after macroscopically complete ablation including biopsies from the neo-Z-line and the former BE segment, and recording of stricture formation. RESULTS: From May 2011 to November 2012, a total of 60 patients (pt) were included in the study [55 pt male (92%); mean age 62 ± 9 years, range 42-79]. Ten patients were excluded from the study. In the remaining 50 pt, Hybrid-APC ablation and check-up endoscopy at 3 months were carried out. Forty-eight out of 50 pt (96%; ITT: 49/60, 82%) achieved macroscopically complete remission after a median of 3.5 APC sessions [SD 2.4; range 1-10]. Freedom from BE was histopathologically observed in 39/50 patients (78%). There was one treatment-related stricture (2%). Minor adverse events of Hybrid-APC were observed in 11 patients (22%). CONCLUSIONS: According to this pilot series, Hybrid-APC was effective and safe for BE ablation in a tertiary referral center. The rate of stricture formation was only 2%. Further studies are required to confirm the present results. GERMAN CLINICAL TRIALS REGISTER: DRKS00003369.
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: K Nadine Phoa; Roos E Pouw; Frederike G I van Vilsteren; Carine M T Sondermeijer; Fiebo J W Ten Kate; Mike Visser; Sybren L Meijer; Mark I van Berge Henegouwen; Bas L A M Weusten; Erik J Schoon; Rosalie C Mallant-Hent; Jacques J G H M Bergman Journal: Gastroenterology Date: 2013-03-28 Impact factor: 22.682
Authors: David I Fudman; Charles J Lightdale; John M Poneros; Gregory G Ginsberg; Gary W Falk; Maureen Demarshall; Milli Gupta; Prasad G Iyer; Lori Lutzke; Kenneth K Wang; Julian A Abrams Journal: Gastrointest Endosc Date: 2014-02-22 Impact factor: 9.427
Authors: Hendrik Manner; Thomas Rabenstein; Oliver Pech; Kirsten Braun; Andrea May; Juergen Pohl; Angelika Behrens; Michael Vieth; Christian Ell Journal: Endoscopy Date: 2013-12-18 Impact factor: 10.093
Authors: C Ell; A May; L Gossner; O Pech; E Günter; G Mayer; R Henrich; M Vieth; H Müller; G Seitz; M Stolte Journal: Gastroenterology Date: 2000-04 Impact factor: 22.682
Authors: Prateek Sharma; John Dent; David Armstrong; Jacques J G H M Bergman; Liebwin Gossner; Yoshio Hoshihara; Janusz A Jankowski; Ola Junghard; Lars Lundell; Guido N J Tytgat; Michael Vieth Journal: Gastroenterology Date: 2006-08-16 Impact factor: 22.682
Authors: Sarina Pasricha; William J Bulsiewicz; Kelly E Hathorn; Srinadh Komanduri; V Raman Muthusamy; Richard I Rothstein; Herbert C Wolfsen; Charles J Lightdale; Bergein F Overholt; Daniel S Camara; Evan S Dellon; William D Lyday; Atilla Ertan; Gary W Chmielewski; Nicholas J Shaheen Journal: Clin Gastroenterol Hepatol Date: 2014-05-09 Impact factor: 11.382
Authors: Nicholas J Shaheen; Prateek Sharma; Bergein F Overholt; Herbert C Wolfsen; Richard E Sampliner; Kenneth K Wang; Joseph A Galanko; Mary P Bronner; John R Goldblum; Ana E Bennett; Blair A Jobe; Glenn M Eisen; M Brian Fennerty; John G Hunter; David E Fleischer; Virender K Sharma; Robert H Hawes; Brenda J Hoffman; Richard I Rothstein; Stuart R Gordon; Hiroshi Mashimo; Kenneth J Chang; V Raman Muthusamy; Steven A Edmundowicz; Stuart J Spechler; Ali A Siddiqui; Rhonda F Souza; Anthony Infantolino; Gary W Falk; Michael B Kimmey; Ryan D Madanick; Amitabh Chak; Charles J Lightdale Journal: N Engl J Med Date: 2009-05-28 Impact factor: 91.245
Authors: Mate Knabe; Sandra Blößer; Jens Wetzka; Christian Ell; Andrea May Journal: United European Gastroenterol J Date: 2018-02-05 Impact factor: 4.623
Authors: Lu Zhang; Binyu Sun; Xi Zhou; QiongQiong Wei; Sicheng Liang; Gang Luo; Tao Li; Muhan Lü Journal: Front Oncol Date: 2021-06-17 Impact factor: 6.244