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Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice

BACKGROUND: High-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in Barrett’s esophagus (BE) are now well-established indications for endoscopic resection (ER). Radiofrequency ablation (RFA) can be combined with ER in case of flat or long-segment BE ablation. We report here our experience of...

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Autores principales: Godat, Sébastien, Marx, Mariola, Caillol, Fabrice, Robert, Maxime, Autret, Aurélie, Bories, Erwan, Pesenti, Christian, Ratone, Jean Philippe, Schoepfer, Alain, Poizat, Flora, Giovannini, Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hellenic Society of Gastroenterology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713341/
https://www.ncbi.nlm.nih.gov/pubmed/34987286
http://dx.doi.org/10.20524/aog.2021.0685
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author Godat, Sébastien
Marx, Mariola
Caillol, Fabrice
Robert, Maxime
Autret, Aurélie
Bories, Erwan
Pesenti, Christian
Ratone, Jean Philippe
Schoepfer, Alain
Poizat, Flora
Giovannini, Marc
author_facet Godat, Sébastien
Marx, Mariola
Caillol, Fabrice
Robert, Maxime
Autret, Aurélie
Bories, Erwan
Pesenti, Christian
Ratone, Jean Philippe
Schoepfer, Alain
Poizat, Flora
Giovannini, Marc
author_sort Godat, Sébastien
collection PubMed
description BACKGROUND: High-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in Barrett’s esophagus (BE) are now well-established indications for endoscopic resection (ER). Radiofrequency ablation (RFA) can be combined with ER in case of flat or long-segment BE ablation. We report here our experience of complementary RFA after widespread ER of neoplastic BE in daily practice. METHOD: We retrospectively reviewed data of 89 patients, treated between 2006 and 2013 by ER alone (group 1) or by ER combined with RFA (group 2). RESULTS: Fifty-five patients in group 1 (7F/48M, mean age 68 years) underwent widespread ER with eradication of residual non-dysplastic BE. Complete eradication of HGD/IMC and intestinal metaplasia (IM) was achieved in 32/32 (100%) and 48/55 (87.3%) patients, respectively. Thirty-four patients in group 2 (3F/31M, mean age 67 years) had a multimodal treatment strategy, with widespread ER followed by RFA. Mean Prague classification of BE in this group was significantly longer (C4.4M6.6 vs. C2.7M4.5, P<0.001). Complete eradication of HGD/IMC and non-dysplastic BE was confirmed in 26/27 (96.3%) and 20/34 (58.8%) patients, respectively. There was no significant difference between groups concerning adverse events (16.4% vs. 23.5%, P=0.58) or recurrence rate of HGD/IMC (9.1% vs. 14.7%, P=0.42). The mismatch rate between preoperative and final histological diagnosis was high in both groups, at 45.5% and 26.5%. CONCLUSIONS: A combination of ER and RFA can treat significantly longer neoplastic BE than ER alone, with the same efficiency and safety. Widespread ER, in contrast, is the only method of obtaining a reliable histological diagnosis.
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spelling pubmed-87133412022-01-04 Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice Godat, Sébastien Marx, Mariola Caillol, Fabrice Robert, Maxime Autret, Aurélie Bories, Erwan Pesenti, Christian Ratone, Jean Philippe Schoepfer, Alain Poizat, Flora Giovannini, Marc Ann Gastroenterol Original Article BACKGROUND: High-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in Barrett’s esophagus (BE) are now well-established indications for endoscopic resection (ER). Radiofrequency ablation (RFA) can be combined with ER in case of flat or long-segment BE ablation. We report here our experience of complementary RFA after widespread ER of neoplastic BE in daily practice. METHOD: We retrospectively reviewed data of 89 patients, treated between 2006 and 2013 by ER alone (group 1) or by ER combined with RFA (group 2). RESULTS: Fifty-five patients in group 1 (7F/48M, mean age 68 years) underwent widespread ER with eradication of residual non-dysplastic BE. Complete eradication of HGD/IMC and intestinal metaplasia (IM) was achieved in 32/32 (100%) and 48/55 (87.3%) patients, respectively. Thirty-four patients in group 2 (3F/31M, mean age 67 years) had a multimodal treatment strategy, with widespread ER followed by RFA. Mean Prague classification of BE in this group was significantly longer (C4.4M6.6 vs. C2.7M4.5, P<0.001). Complete eradication of HGD/IMC and non-dysplastic BE was confirmed in 26/27 (96.3%) and 20/34 (58.8%) patients, respectively. There was no significant difference between groups concerning adverse events (16.4% vs. 23.5%, P=0.58) or recurrence rate of HGD/IMC (9.1% vs. 14.7%, P=0.42). The mismatch rate between preoperative and final histological diagnosis was high in both groups, at 45.5% and 26.5%. CONCLUSIONS: A combination of ER and RFA can treat significantly longer neoplastic BE than ER alone, with the same efficiency and safety. Widespread ER, in contrast, is the only method of obtaining a reliable histological diagnosis. Hellenic Society of Gastroenterology 2022 2021-12-06 /pmc/articles/PMC8713341/ /pubmed/34987286 http://dx.doi.org/10.20524/aog.2021.0685 Text en Copyright: © Hellenic Society of Gastroenterology https://creativecommons.org/licenses/by-nc-sa/3.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Godat, Sébastien
Marx, Mariola
Caillol, Fabrice
Robert, Maxime
Autret, Aurélie
Bories, Erwan
Pesenti, Christian
Ratone, Jean Philippe
Schoepfer, Alain
Poizat, Flora
Giovannini, Marc
Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title_full Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title_fullStr Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title_full_unstemmed Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title_short Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett’s esophagus in daily practice
title_sort benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic barrett’s esophagus in daily practice
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713341/
https://www.ncbi.nlm.nih.gov/pubmed/34987286
http://dx.doi.org/10.20524/aog.2021.0685
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