A Multi-Center Randomized Trial Comparing Stepwise Radical Endoscopic Resection Versus Radiofrequency Ablation for Barrett Esophagus Containing High-Grade Dysplasia and/or Early Cancer

Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 10 cm

“…There were no severe complications, and, remarkably, these results were achieved by using an apparently similar number of treatments as are used for BE Ͻ10 cm. [8][9][10][11][12][13]15 Our data are in accordance with the reported rates of complete remission of neoplasia and IM by Shaheen et al, 13 even though longer BE segments were treated in our study. However, in contrast to the study of Shaheen et al, our treatment protocol permitted two instead of one circumferential ablation as well as an escape treatment with ER after the maximum number of RFA treatments in the case of residual endoscopic BE.…”

“…[8][9][10][11][12][13][14][15] In addition, studies have shown that the regenerated neosquamous epithelium after RFA is free of the oncogenetic abnormalities as present in the BE before RFA and that subsquamous foci of IM (buried BE) are rare. 16 Furthermore, RFA preserves the diameter, compliance, and motility of the esophagus and is associated with a low rate of stenosis.…”

Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett's neoplasia

“…Indications for piecemeal ER were: (1) monotherapy for removal of early neoplastic lesions (generally for patients with BE Ͼ5 cm), 1 (2) as part of a stepwise radical endoscopic resection protocol of the whole BE in multiple sessions, [9][10][11] or (3) removal of visible abnormalities before additional ablation therapy. [11][12][13] Endoscopic procedures All ER procedures were performed at the Academic Medical Center Amsterdam, St. Antonius Hospital Nieuwegein, Catharina Hospital Eindhoven, or the University Hospitals Leuven.…”

“…[11][12][13] Endoscopic procedures All ER procedures were performed at the Academic Medical Center Amsterdam, St. Antonius Hospital Nieuwegein, Catharina Hospital Eindhoven, or the University Hospitals Leuven. The first 34 patients were consecutively included and randomized at the Academic Medical Center and treated by an endoscopist with extensive experience in ER with the use of both techniques (J.B.).…”

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

“…Studies to date, including the landmark randomized controlled trial of Shaheen et al (ablation of intestinal metaplasia [AIM] dysplasia trial), demonstrate a clear benefit for RFA in the treatment of high-grade dysplasia, ideally with endoscopic mucosal resection of any mucosal abnormalities prior to application [5,8]. In addition, preliminary results of a randomized controlled clinical trial of circumferential endoscopic mucosal resection versus focal endoscopic mucosal resection plus RFA for highgrade dysplasia and early adenocarcinoma suggest that the two techniques are comparable for the important endpoints of elimination of neoplasia and intestinal neoplasia, but the complication rate for endoscopic mucosal resection plus RFA is substantially lower [9]. Thus, RFA represents a clear advance for the management of patients with highgrade dysplasia.…”