Argon Plasma Coagulation in the Treatment of Barrett’s High-Grade Dysplasia and In Situ Adenocarcinoma

Laethem, Jean Luc Van; Jagodzinski, Robert; Peny, Marie-Odile; Cremer, Michel; Devière, Jacques

doi:10.1055/s-2001-12803

Cited by 109 publications

(44 citation statements)

References 13 publications

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“…Although this hypothesis cannot be confirmed, the 0.07% of subsquamous IM still compares favorably to the 53% rate of buried glands reported after other ablation techniques. [14][15][16][17][18][19][20][21] Our findings were in concordance with the absence of buried glands in 3,007 neosquamous biopsies after RF ablation in the 100 patients described by Sharma et al 25 Further studies on the adequacy of biopsies from the neosquamous epithelium after RFA should, however, clarify this issue further. Ablation at the GE-junction using the HALO 360 catheter may be difficult, since the often tortuous course of the distal esophagus and widening into a hiatal hernia, present in most BE patients, may impede good circumferential contact of the electrode with the mucosa at this level.…”

Section: Discussionsupporting

confidence: 78%

“…[10][11][12] Ablating the residual BE with argon plasma coagulation (APC) or photodynamic therapy (PDT) has also been described, but these techniques do not always result in complete eradication of all Barrett epithelium, preexisting oncogenetic alterations may still be found in residual areas of BE, and both techniques are associated with issues of variable ablation depth and safety. [14][15][16][17][18][19] Furthermore, after APC and PDT, areas of IM may become hidden underneath the newly formed squamous epithelium after ablation (a.k. a., "buried Barrett"), and some fear that these buried glands may progress to dysplasia and adenocarcinoma without being detected endoscopically.…”

Section: Introductionmentioning

confidence: 99%

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Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Pouw

Gondrie

Sondermeijer

et al. 2008

Journal of Gastrointestinal Surgery

113

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Background Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008. Methods Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloonbased catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated. Results Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n=16), high-grade dysplasia (n=12), low-grade dysplasia (n=3)]. Worst histology remaining after resection was high-grade (n=32), low-grade (n=10), or no (n=2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n=3) and transient dysphagia (n=4). After 21 months of follow-up (interquartile range 10-27), no dysplasia had recurred. Conclusions Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Pouw

Gondrie

Sondermeijer

et al. 2008

Journal of Gastrointestinal Surgery

113

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“…To prevent development of such metachronous lesions, ER can be combined with ablative therapy of all remaining Barrett's. Ablative tools used for this purpose are for example photodynamic therapy (PDT) or argon plasma coagulation (APC) [15,16,17,18,19]. PDT and APC, however, have significant shortcomings.…”

Section: Introductionmentioning

confidence: 99%

“…PDT and APC, however, have significant shortcomings. First, they often do not result in complete ablation of the whole Barrett's segment [15,16,17,18,19]. Second, studies have shown that oncogenetic alterations, as present in BE prior to ablation, can still be found in areas of residual BE and these may be associated with recurrence of dysplasia [20].…”

Section: Introductionmentioning

confidence: 99%

“…Third, foci of intestinal metaplasia (IM) may be hidden underneath the neosquamous mucosa after treatment (a.k.a., ‘buried Barrett's') and some fear that these areas may progress to cancer without being detected endoscopically due to their ‘hidden' nature [21,22]. Lastly, PDT and APC are associated with complications of which esophageal stenosis is the most relevant [15,16,17,18,19]. Stepwise circumferential and focal radiofrequency ablation (RFA) combined with ER for focal lesions is a relatively new endoscopic treatment modality for BE [23,24,25] (fig.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Resection and Radiofrequency Ablation for Early Esophageal Neoplasia

Belghazi

Bergman

Pouw³

2016

Dig Dis

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Background: In the last few decades, endoscopic treatment of early neoplastic lesions in the esophagus has established itself as a valid and less invasive alternative to surgical resection. Endoscopic resection (ER) is the cornerstone of endoscopic therapy. Next to the curative potential of ER, by removing neoplastic lesions, ER may also serve as a diagnostic tool. The relatively large tissue specimens obtained with ER enable accurate histological staging of a lesion, allowing for optimal decision-making for further patient management. ER was pioneered in Japan, mainly for the resection of gastric lesions and squamous esophageal neoplasia, and also Western countries have been increasingly implementing ER in the treatment of early gastroesophageal neoplasia, mostly associated with Barrett's esophagus (BE). In BE, however, there is still a risk of metachronous lesions in the remainder of the Barrett's after focal ER. Additional treatment of all Barrett's mucosa is therefore advised. Currently, the most effective method for this is by using radiofrequency ablation (RFA). This review will provide an overview of indications for ER and RFA. Key Messages and Conclusions: Endoscopic management of early esophageal neoplasia is a safe and valid alternative to surgery and is nowadays the treatment of choice. ER is the mainstay of endoscopic management of early esophageal neoplasia since it allows for removal of neoplastic lesions and provides a large tissue specimen for histological evaluation. In case of early neoplasia in BE, focal ER should be complemented by eradication of the remaining Barrett's mucosa. RFA has proven to be a safe and effective modality to achieve complete eradication of Barrett's mucosa.

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Thermal Endoscopic Therapy of Barrett's Esophagus

Devière¹

2006

Barrett's Esophagus and Esophageal Adenocarcinoma

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Argon Plasma Coagulation in the Treatment of Barrett’s High-Grade Dysplasia and In Situ Adenocarcinoma

Abstract: APC is safe and effective in the management of HGD and in situ adenocarcinoma associated with BE, and might represent an interesting alternative in selected patients who are not candidates for surgery.

Cited by 109 publications

References 13 publications

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Endoscopic Resection and Radiofrequency Ablation for Early Esophageal Neoplasia

Thermal Endoscopic Therapy of Barrett's Esophagus

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