Comparative outcomes of radiofrequency ablation for Barrett's oesophagus with different baseline histology

Tan, Wei; Rattan, Arti; O’Donovan, Maria; Nuckcheddy, Tara; Alias, Bincy; Sujendran, Vijay; Pietro, Massimiliano di

doi:10.1177/2050640617752183

Cited by 2 publications

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“…Although we applied a rigorous protocol with two consecutive biopsies to confirm CR-D or CR-IM, overall follow-up was relatively short, therefore, our data are insufficient to provide information on the durability of RFA comparing these two protocols. However, the long-term durability of RFA in one of the two centers has been reported elsewhere [7]. Third, RFA was performed in tertiary institutions with high-volume caseload and experienced endoscopists, therefore, the results of this study may not necessarily reflect the practice in small-volume centers.…”

Section: Casementioning

confidence: 83%

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Standard versus simplified radiofrequency ablation protocol for Barrett’s esophagus: comparative analysis of the whole treatment pathway

et al. 2020

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Background and study aims The standard radiofrequency ablation (RFA) protocol for Barrett’s esophagus (BE) encompasses an intermediary cleaning phase between two ablation sessions. A simplified protocol omitting the cleaning phase is less labor-intensive but equally effective in studies based on single ablation procedures. The aim of this study was to compare efficacy and safety of the standard and simplified RFA protocols for the whole treatment pathway for BE, including both circumferential and focal devices. Patients and methods We performed a retrospective analysis of prospectively collected data on patients receiving RFA between January 2007 and August 2017 at two institutions. Outcomes assessed were: 1) complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM) at 18 months; and 2) rate of esophageal strictures. Results One hundred forty-five patients were included of whom 73 patients received the standard and 72 patients received the simplified protocol. CR-D was achieved in 94.5 % and 95.8 % of patients receiving the standard and simplified protocol, respectively (P = 0.71). CR-IM was achieved in 84.9 % and 77.8 % of patients treated with the standard and simplified protocol, respectively (P = 0.27). Strictures were significantly more common among patients who received the simplified protocol (12.5 %) compared to the standard protocol (1.4 %; P = 0.008). The median number of esophageal dilations was one. Conclusion The simplified RFA protocol is as effective as the standard protocol in eradicating BE but carries a higher risk of strictures. This needs to be taken into account, particularly in patients with higher pretreatment risk of strictures, such as those with esophageal narrowing from previous endoscopic mucosal resection (EMR).

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Section: Casementioning

confidence: 83%

“…BE predisposes to esophageal adenocarcinoma, an aggressive cancer with an overall 5-year survival of only 17 % [3]. Radiofrequency ablation (RFA) has been established as a safe, effective and durable treatment for flat, dysplastic BE,[4][5][6][7]. RFA is delivered using the BARRX system, which comprises a circumferential ablation device (BARRX 360…”

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confidence: 99%

Standard versus simplified radiofrequency ablation protocol for Barrett’s esophagus: comparative analysis of the whole treatment pathway

et al. 2020

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“…Non-Caucasian race, Increased age, longer circumferential and maximal length of BE, increasing number of RFA sessions were predictive of recurrence. 79,[82][83][84]91 Higher grade of dysplasia at baseline histology was not associated with recurrence in a meta-analysis 79 while predictive for recurrence for others. 83,92 Sex was not associated with recurrence prediction.…”

Section: Durabilitymentioning

confidence: 94%

Optimizing Outcomes with Radiofrequency Ablation of Barrett's Esophagus

Leclercq

Bisschops

2021

Gastrointestinal Endoscopy Clinics of North America

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Barrett's esophagus (BE) is the precursor for esophageal adenocarcinoma (EAC). The risk of progression from nondysplastic BE (NDBE) to EAC is 30-fold to 125-fold greater than in the general population, increasing progressively with different stages of dysplasia. 1,2 Progression occurs stepwise from nondysplastic intestinal metaplasia to low-grade to high-grade dysplasia and ultimately to adenocarcinoma. 3 KEYWORDS • Barrett's esophagus • Radiofrequency ablation • Outcomes KEY POINTS• Barrett's esophagus (BE) is the precursor for esophageal adenocarcinoma (EAC). The risk of progression from non-dysplastic BE to EAC increases progressively with stages of dysplasia.• If early-stage cancer or high-grade dysplasia is diagnosed, endoscopic therapy is the treatment of choice with better safety profile and similar efficacy compared with esophagectomy.• Endoscopic therapy is based on a "2-step concept": visible lesions are endoscopically removed and the remaining flat BE is ablated to prevent metachronous neoplasia.• Radiofrequency ablation (RFA) effectively eradicates dysplastic Barrett esophagus (BE) and reduces the metachronous risk of esophageal adenocarcinoma (EAC), with an acceptable low complication rate.• After achieving complete eradication of intestinal metaplasia (CE-IM) by RFA, dysplasia recurrence rate is approximately 2% per patient year of follow-up time, justifying postablation surveillance.

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Comparative outcomes of radiofrequency ablation for Barrett's oesophagus with different baseline histology

Abstract: Baseline histology is not a predictor of RFA response. Once CRD and CRIM are achieved, these effects are durable over time.

Cited by 2 publications

References 20 publications

Standard versus simplified radiofrequency ablation protocol for Barrett’s esophagus: comparative analysis of the whole treatment pathway

Standard versus simplified radiofrequency ablation protocol for Barrett’s esophagus: comparative analysis of the whole treatment pathway

Optimizing Outcomes with Radiofrequency Ablation of Barrett's Esophagus

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