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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus.Clin Gastroenterol Hepatol. 2006; 4: 566-572
- Dysplasia in Barrett's esophagus: limitations of current management strategies.Am J Gastroenterol. 2005; 100: 927-935
- Early adenocarcinoma in Barrett's oesophagus.Br J Surg. 1997; 84: 1470-1473
- Pro: esophagectomy is the treatment of choice for high-grade dysplasia in Barrett's esophagus.Am J Gastroenterol. 2006; 101: 2177-2179
- Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett's esophagus.Am J Gastroenterol. 2007; 102: 2380-2386
- Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus.Gastroenterology. 2007; 132: 1226-1233
- A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data.Am J Gastroenterol. 2008; 103: 1340-1345
- National Institute for Health and Clinical Excellence Web site.Barrett's oesophagus: ablative therapy for the treatment of Barrett's oesophagus. National Institute for Health and Clinical Excellence, LondonIssued August 2010
- Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus.Gastrointest Endosc. 2005; 61: 506-514
- Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer).Gastrointest Endosc. 2007; 65: 3-10
- Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett's esophagus.Gastroenterology. 2009; 137: 815-823
- Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus.Gut. 2008; 57: 1200-1206
- Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients.Gut. 2010; 59: 1169-1177
- Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus.Gastrointest Endosc. 2010; 71: 697-703
- The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria.Gastroenterology. 2006; 131: 1392-1399
- Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial.Gastrointest Endosc. 2005; 62: 488-498
- Radiofrequency ablation in Barrett's esophagus with dysplasia.N Engl J Med. 2009; 360: 2277-2288
- Complete Barrett's eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma—an American single-center experience.Am J Gastroenterol. 2009; 104: 2684-2692
- Endoscopic resection for Barrett's high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit.Am J Gastroenterol. 2010; 105: 1276-1283
- Circumferential EMR and complete removal of Barrett's epithelium: a new approach to management of Barrett's esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma.Gastrointest Endosc. 2003; 57: 854-859
- Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study.Am J Gastroenterol. 2006; 101: 1449-1457
- Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett's oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial.Gut. 2011; 60: 765-773
- Acid suppression and reepithelialization after ablation of Barrett's esophagus.Dig Dis. 2000; 18: 232-239
- Detection of intestinal metaplasia after successful eradication of Barrett's esophagus with radiofrequency ablation.Dig Dis Sci. 2011; 56: 1996-2000
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.