We would like to respond to the letter of De Caestecker et al
1
in reply to our editorial that reflected on the BRIDE study, a randomized pilot study comparing radiofrequency ablation with argon plasma coagulation for the treatment of Barrett’s esophagus (BE).2
Our main point of disagreement is that in the BRIDE study, complete eradication of dysplasia (CE-D) at 12 months was chosen as an endpoint. Although eradication of dysplasia may be the most relevant short-term outcome for the patient, we think that in light of a study comparing 2 ablation techniques, CE-D is a suboptimal endpoint, and its clinical relevance is questionable.As described in current guidelines, the rationale of ablation therapy for BE with dysplasia is to eradicate the whole BE, not only to treat the dysplasia. Using CE-D as an endpoint is therefore clinically not relevant. Also, this endpoint is hampered by biopsy sampling error and interobserver agreement between pathologists.
Furthermore, the statement that annual follow-up is recommended indefinitely after ablation therapy is, in our opinion, quite blunt. Maybe this is recommended in the referenced article; however, on the basis of our long-term outcomes after radiofrequency ablation and deliberate calculations on the optimal follow-up strategy, which we are currently working on, we dare to say that follow-up can safely be stopped at some point, provided that complete eradication of Barrett’s esophagus has been achieved.
References
- Randomized studies for Barrett’s ablation: identifying the most cost-effective solutions by keeping an open mind.Gastrointest Endosc. 2020; 91: 1219-1220
- Randomized studies for Barrett’s ablation: just because we can doesn’t mean we should.Gastrointest Endosc. 2019; 89: 690-692
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- Randomized studies for Barrett’s ablation: identifying the most cost-effective solutions by keeping an open mindGastrointestinal EndoscopyVol. 91Issue 5
- PreviewWe would like to respond to the editorial by van Munster et al,1 which accompanied our pilot trial (BRIDE) comparing argon plasma coagulation (APC) with radiofrequency ablation (RFA) for the ablation of dysplastic Barrett’s esophagus (BE).2 They conclude that RFA is the established standard, modalities such as APC being reserved for special situations (strictures, refractory BE), and that comparative randomized controlled trials (RCTs) versus RFA are not warranted unless safety and efficacy have been established with large prospective trials, like EURO II for RFA.
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