Outcomes of radiofrequency ablation by manual versus self-sizing circumferential balloon catheters for the treatment of dysplastic Barrett's esophagus: a multicenter comparative cohort study
| Autor: | David E. Fleischer, Ramona M. Lansing, Francisco C. Ramirez, Kristyn Maixner, Michael B. Wallace, Michele L. Johnson, Allon Kahn, Ross A. Dierkhising, Cadman L. Leggett, Harshith Priyan, Prasad G. Iyer, Herbert C. Wolfsen, Kenneth K. Wang |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Catheters Esophageal Neoplasms Radiofrequency ablation medicine.medical_treatment Perforation (oil well) law.invention Cohort Studies 03 medical and health sciences Barrett Esophagus 0302 clinical medicine law medicine Humans Radiology Nuclear Medicine and imaging Esophagus medicine.diagnostic_test business.industry Gastroenterology Balloon catheter medicine.disease Ablation Endoscopy Surgery Catheter medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Barrett's esophagus Catheter Ablation 030211 gastroenterology & hepatology Esophagoscopy business |
| Zdroj: | Gastrointestinal endoscopy. 93(4) |
| ISSN: | 1097-6779 |
| Popis: | Background and Aims Radiofrequency ablation (RFA) is the preferred ablative modality for treating dysplastic Barrett’s esophagus. The recently introduced self-sizing circumferential ablation catheter eliminates the need for a sizing balloon. Although it enhances efficiency, outcomes have not been compared with the previous manual-sizing catheter. We evaluated the comparative safety and efficacy of these 2 ablation systems in a large, multicenter cohort. Methods Patients undergoing RFA at 3 tertiary care centers from 2005 to 2018 were included. Circumferential RFA was performed in a standard fashion, followed by focal RFA as needed. Outcomes were compared between the self-sizing and manual-sizing groups. The primary outcome was the rate of adverse events, including strictures, perforation, and bleeding. Secondary outcomes were procedure time and treatment efficacy, as assessed by rates and time to complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM). Results Three hundred eighteen patients were included, 90 (28.3%) treated with the self-sizing catheter and 228 (71.7%) with the manual-sizing catheter. Twenty-one patients (6.6%) developed strictures (8 [8.9%] in the self-sizing group and 13 [5.7%] in the manual-sizing group, P = .32). Of the self-sizing strictures, 75% occurred at the 12J dose before widespread adoption of the current 10J treatment standard. One patient developed bleeding, and no perforations were encountered. Procedure time was significantly shorter in the self-sizing group. No significant differences were observed in rates of and time to CE-D and CE-IM. Conclusions These findings suggest that both systems are comparable in safety and efficacy. The use of the self-sizing system may enhance the efficiency of RFA for treating dysplastic Barrett’s esophagus. |
| Databáze: | OpenAIRE |
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