Radiofrequency ablation of Barrett's oesophagus with confirmed low-grade dysplasia reduces risk of development of high-grade dysplasia and adenocarcinoma

Abstract

Commentary on: Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomised clinical trial. JAMA 2014;311:1209-17. ContextThe clinical management of patients with suspected low-grade dysplasia in Barrett's oesophagus traditionally involves confirming the diagnosis by repeated systematic biopsy on strong acid suppression therapy and expert histopathological review of the sampled mucosa. Thereafter, patients are offered intensive surveillance with a shorter interval than in non-dysplastic Barrett's oesophagus (due to the increase in risk of development of high-grade dysplasia and adenocarcinoma); however, some patients may also revert to non-dysplastic mucosa.Endoscopic ablative techniques eradicate the premalignant tissue, thereby obviating the need for potential resection or oncological therapy (and the morbidity, mortality and resource associated with these) with promising short-term outcomes. Long-term outcomes are as yet unknown. MethodsThis is a randomised controlled trial of 136 patients with low-grade dysplasia within Barrett's oesophagus, comparing endoscopic radiofrequency ablation to surveillance alone (randomised 1:1) at nine European centres. The intended follow-up was 3 years, with planned interim analyses at 50% and 75% follow-up time. The primary outcome measures were development of high-grade dysplasia or adenocarcinoma during the course of follow-up. Secondary outcome measures were: complete histological eradication of dysplasia, complete histological eradication of intestinal metaplasia and adverse events.The power calculation required a sample size of 120 patients (based on 14% control subjects and 1% of intervention subjects developing the primary end points). A 5% dropout rate was anticipated. Inclusion criteria included age 18-85 years, life expectancy of at least 2 years, diagnosis of low-grade dysplasia within 18 months, and an index qualifying endoscopy within 6 months of randomisation to exclude high-grade dysplasia, adenocarcinoma and any visible abnormalities within the segment. There was rigorous central pathological control.Ablation was undertaken every 3 months using the circumferential HALO 360+ device (up to two sessions) and focal HALO 90 device (up to three sessions) with the option of subsequent endoscopic mucosal dissection or argon plasma coagulation to complete endoscopic and histological ablation of the Barrett's segment. Surveillance endoscopies with four-quadrant biopsy every 2 cm were undertaken every three months from completion of treatment in the intervention arm and randomisation in the control arm. FindingsFive hundred and eleven patients were initially screened, and over half were excluded following pathological review. Seventy patients were randomised and 68 received the intended management in each group. The trial was terminated early due to the significant difference in outcome found at the second interim analysis (at which point all patients had complete...

Perirenal Fat and Association With Metabolic Risk Factors

“…Radiofrequency ablation of BE with confirmed LGD can reduce risk of developing HGD and adenocarcinoma. 31 The treatment of early or locally advanced EAC may differ greatly and influence the medical cost largely. 32 Therefore, more participants in AS group can lead to detecting more early diseases and reduce postdiagnosis medical cost.…”

Effectiveness of focal vs. balloon radiofrequency ablation devices in the treatment of Barrett’s esophagus

“…16 Similarly, a few other recently published studies have shown that RFA is effective in eradicating dysplasia. 17,18 The above data proved beyond a doubt that RFA has a significant role in treating BE and dysplasia.…”

“…Owing to the significant superiority of RFA compared to endoscopic surveillance alone in decreasing progression of LGD to either HGD or esophageal cancer and concern for patient safety if the trial continued, the study was terminated earlier than expected 16 . Similarly, a few other recently published studies have shown that RFA is effective in eradicating dysplasia 17 , 18 . The above data proved beyond a doubt that RFA has a significant role in treating BE and dysplasia.…”