Maximilien Barret1, Kamar Belghazi1, Bas L A M Weusten2, Jacques J G H M Bergman1, Roos E Pouw1. 1. Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands; Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Abstract
BACKGROUND AND AIMS: The management of early neoplasia in Barrett's esophagus (BE) requires endoscopic resection of visible lesions, followed by radiofrequency ablation (RFA) of the remaining BE. We evaluated the safety and efficacy of combining endoscopic resection and focal RFA in a single endoscopic session in patients with early BE neoplasia. METHODS: This was a retrospective analysis of patients with early BE neoplasia and a visible lesion undergoing combined endoscopic resection and focal RFA in a single session. Consecutive ablation procedures were performed every 8 to 12 weeks until complete endoscopic and histologic eradication of dysplasia and intestinal metaplasia were reached. RESULTS: Forty patients were enrolled, with a median C1M2 BE segment, a visible lesion with a median diameter of 15 mm, and invasive carcinoma in 68% of cases. Endoscopic resection was performed by using the multiband mucosectomy technique in 80% of cases, and the Barrx(90) catheter (Barrx Medical, Sunnyvale, Calif) was used for focal ablation. When an intention-to-treat analysis was used, both complete remission of all neoplasia and intestinal metaplasia were 95% after a median follow-up of 19 months. Stenoses occurred in 33% of cases and were successfully managed with a median number of 2 dilations. In 43% of patients, 1 single-session treatment resulted in complete histologic remission of intestinal metaplasia. CONCLUSIONS: Combining endoscopic resection and focal RFA in a single session appears to be effective. Less-aggressive RFA regimens could limit the adverse event rates.
BACKGROUND AND AIMS: The management of early neoplasia in Barrett's esophagus (BE) requires endoscopic resection of visible lesions, followed by radiofrequency ablation (RFA) of the remaining BE. We evaluated the safety and efficacy of combining endoscopic resection and focal RFA in a single endoscopic session in patients with early BE neoplasia. METHODS: This was a retrospective analysis of patients with early BE neoplasia and a visible lesion undergoing combined endoscopic resection and focal RFA in a single session. Consecutive ablation procedures were performed every 8 to 12 weeks until complete endoscopic and histologic eradication of dysplasia and intestinal metaplasia were reached. RESULTS: Forty patients were enrolled, with a median C1M2 BE segment, a visible lesion with a median diameter of 15 mm, and invasive carcinoma in 68% of cases. Endoscopic resection was performed by using the multiband mucosectomy technique in 80% of cases, and the Barrx(90) catheter (Barrx Medical, Sunnyvale, Calif) was used for focal ablation. When an intention-to-treat analysis was used, both complete remission of all neoplasia and intestinal metaplasia were 95% after a median follow-up of 19 months. Stenoses occurred in 33% of cases and were successfully managed with a median number of 2 dilations. In 43% of patients, 1 single-session treatment resulted in complete histologic remission of intestinal metaplasia. CONCLUSIONS: Combining endoscopic resection and focal RFA in a single session appears to be effective. Less-aggressive RFA regimens could limit the adverse event rates.
Authors: S N van Munster; E A Nieuwenhuis; B L A M Weusten; L Alvarez Herrero; A Bogte; A Alkhalaf; B E Schenk; E J Schoon; W Curvers; A D Koch; S E M van de Ven; P J F de Jonge; T Tang; W B Nagengast; F T M Peters; J Westerhof; M H M G Houben; Jacques J G H M Bergman; R E Pouw Journal: J Gastrointest Surg Date: 2020-11-02 Impact factor: 3.452
Authors: Sanne van Munster; Esther Nieuwenhuis; Bas L A M Weusten; Lorenza Alvarez Herrero; Auke Bogte; Alaa Alkhalaf; B E Schenk; Erik J Schoon; Wouter Curvers; Arjun D Koch; Steffi Elisabeth Maria van de Ven; Pieter Jan Floris de Jonge; Tjon J Tang; Wouter B Nagengast; Frans T M Peters; Jessie Westerhof; Martin H M G Houben; Jacques Jghm Bergman; Roos E Pouw Journal: Gut Date: 2021-03-22 Impact factor: 23.059