Long-term outcomes after endoscopic treatment for Barrett's neoplasia with radiofrequency ablation +/- endoscopic resection

Autor: 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, S, Nedjat
Přispěvatelé: Gastroenterology and hepatology, CCA - Imaging and biomarkers, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Gastroenterology & Hepatology
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Gut. BMJ Publishing Group
Gut
van Munster, S, Nieuwenhuis, E, Weusten, B L A M, Alvarez Herrero, L, Bogte, A, Alkhalaf, A, Schenk, B E, Schoon, E J, Curvers, W, Koch, A D, van de Ven, S E M, de Jonge, P J F, Tang, T J, Nagengast, W B, Peters, F T M, Westerhof, J, Houben, M H M G, Bergman, J J G H M & Pouw, R E 2021, ' Long-term outcomes after endoscopic treatment for Barrett's neoplasia with radiofrequency ablation ± endoscopic resection: Results from the national Dutch database in a 10-year period ', Gut . https://doi.org/10.1136/gutjnl-2020-322615
Gut, 71(2), 265-276. BMJ PUBLISHING GROUP
Gut, 71(2), 265-276. BMJ Publishing Group
ISSN: 0017-5749
DOI: 10.1136/gutjnl-2020-322615
Popis: ObjectiveRadiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DesignEndoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.ResultsAfter ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0–1; 1–2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22–69) and 4 endoscopies (1–5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.ConclusionIn a setting of centralised care, RFA±ER is effective for eradication of Barrett’s related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.Netherlands trial register numberNL7039.
Databáze: OpenAIRE
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