Background
Endoluminal therapy is an option for selected patients with Barrett's esophagus and
high-grade dysplasia or early cancer.
Objective
To assess long-term outcomes of patients treated with endoluminal therapy with the
goal of complete eradication of all dysplasia and intestinal metaplasia.
Design
Retrospective cohort study.
Patients
Selected patients referred with dysplastic Barrett's esophagus.
Intervention
Endoluminal therapy combining resection and photodynamic therapy, radiofrequency ablation,
and/or argon plasma coagulation treatment was individualized based on patient and
lesion characteristics, technique evolution, and interval response.
Main Outcome Measurements
We assessed complete eradication of dysplasia, all intestinal metaplasia, and recurrences.
Results
A total of 166 patients were treated and had at least 1 year of follow-up. Complete
elimination of neoplasia was achieved in 157 patients (95%) and complete elimination
of intestinal metaplasia in 137 patients (83%). After therapy, patients were followed
for 33 (range 18-58) months. Among patients who achieved complete elimination of intestinal
metaplasia, subsequent recurrent intestinal metaplasia was detected in 48 (35%) and
dysplasia in 12 (9%). Among those who achieved only complete elimination of dysplasia,
recurrent dysplasia was detected in 6 of 19 patients (32%). Multifocal dysplasia and
patient's age were dysplasia and/or carcinoma recurrence risk factors in the multivariable
and univariable analyses. Complete elimination of intestinal metaplasia was a protective
factor in the univariable analysis. Retreatment achieved remission in 90% of cases.
Forty-two patients (23.9%) had complications, including 21 with stricture (11.9%)
and 1 treatment-related death.
Limitations
Retrospective study and evolution of endoscopic modalities.
Conclusion
Multiple-mode endoluminal therapy for Barrett's esophagus with high-grade dysplasia
or early cancer with intention to complete eradication of all intestinal metaplasia
was successful, with low observed recurrence of dysplasia or cancer. However, recurrence
of intestinal metaplasia occurs in one-third of cases and supports continued endoscopic
surveillance even after complete eradication.
Abbreviations:
APC (argon plasma beam coagulation), BE (Barrett's esophagus), HGD (high-grade dysplasia), LGD (low-grade dysplasia), PDT (photodynamic therapy), RFA (radiofrequency ablation)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
October 8,
2012
Received:
May 21,
2012
Footnotes
DISCLOSURE: C. Guarner-Argente received financial support from the Instituto de Salud Carlos III, Government of Spain (BAE grant 2010: BA10-00011) and from the Societat Catalana de Digestologia. G. Falk is a consultant for CDX and C2-Theraptutics. No other financial relationships relevant to this publication were disclosed.
See CME section; p. 280.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
