Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study

Strauss, Adam C.; Agoston, Agoston T.; Dulai, Parambir S.; Srivastava, Amitabh; Rothstein, Richard I.

doi:10.1007/s00464-014-3629-0

Cited by 24 publications

(21 citation statements)

References 28 publications

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“…This included 21 RFA studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. 9,12,14,15,18,21,22,27,29,30,32,39-41,43,47,49,51,53,54 Figure 1 shows the schematic diagram of study selection.…”

Section: Resultsmentioning

confidence: 99%

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Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Krishnamoorthi

Singh

Ragunathan

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Previous estimates of incidence of intestinal metaplasia (IM) recurrence after achieving complete remission of IM (CRIM) through endoscopic therapy of Barrett's esophagus (BE) have varied widely. We performed a systematic review and meta-analysis of studies to estimate an accurate recurrence risk after CRIM. Methods We performed a systematic search of multiple literature databases through June 2015 to identify studies reporting long-term follow-up after achieving CRIM through endoscopic therapy. Pooled incidence rate (IR) of recurrent IM, dysplastic BE, and high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) per person-year of follow-up after CRIM was estimated. Factors associated with recurrence were also assessed. Results We identified 41 studies that reported 795 cases of recurrence in 4443 patients over 10,427 patient-years of follow-up. This included 21 radiofrequency ablation studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. Pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC after radiofrequency ablation were 9.5% (95% CI, 6.7-12.3), 2.0% (95% CI, 1.3-2.7), and 1.2% (95% CI, .8-1.6) per patient-year, respectively. When all endoscopic modalities were included, pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC were 7.1% (95% CI, 5.6-8.6), 1.3% (95% CI, .8-1.7), and .8% (95% CI, .5-1.1) per patient-year, respectively. Substantial heterogeneity was noted. Increasing age and BE length were predictive of recurrence; 97% of recurrences were treated endoscopically. Conclusions The incidence of recurrence after achieving CRIM through endoscopic therapy was substantial. A small minority of recurrences were dysplastic BE and HGD/EAC. Hence, continued surveillance after CRIM is imperative. Additional studies with long-term follow-up are needed.

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Section: Resultsmentioning

confidence: 99%

“…Fourteen of the 41 included studies were multicenter studies. 12,21,29,34,39,41,44,47,49-51,53,54 Mean patient age at endoscopic therapy was 61.4 years, and 78.9% were men. The median of average follow-up after CRIM was 2.5 years, ranging from 1 year to 10.5 years in individual studies.…”

Section: Resultsmentioning

confidence: 99%

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Krishnamoorthi

Singh

Ragunathan

et al. 2016

Gastrointestinal Endoscopy

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“…In addition, the recurrence of dysplasia and neoplasia is reduced by the use of ablative therapy to eliminate residual intestinal metaplasia following induction of remission in IMC by EMR [7,32,33]. This approach has been shown to be comparable to that of esophagectomy in both subjects with HGD and IMC [7,34] The current recommendations from the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), American Society for M A N U S C R I P T…”

Section: Hgd Imcmentioning

confidence: 93%

Endoscopic therapy for Barrett's oesophagus

Blevins

Iyer

2015

Best Practice & Research Clinical Gastroenterology

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“…Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), is also recommended for select individuals with nondysplastic BE who are judged to be at increased risk for further neoplastic progression. 104, 106, 107 To complement the early detection and mucosal ablation/resection in management of patients with BE, a need exists for chemopreventive agents. Three classes of medications are potentially beneficial in reducing the cancer risk of BE: antacids, anti-inflammatory drugs, and antibiotics, of which antacids are the only medication routinely used in clinical practice in the treatment of reflux disorders.…”

Section: Potential Targets For Chemoprevention Of Esophageal Adenocarmentioning

confidence: 99%

Microbiome and potential targets for chemoprevention of esophageal adenocarcinoma

Neto

Whitaker

Pei

2016

Seminars in Oncology

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Esophageal cancer is one of the deadliest cancers, with a dismal prognosis. It is increasingly recognized that esophageal cancer is a heterogeneous disease. It can be subdivided into two distinct groups: squamous cell carcinoma and adenocarcinoma, based on histological appearance. In the Western world, the incidence of squamous cell carcinoma was considerably higher than esophageal adenocarcinoma (EA) until the 1990s when, due to a dramatic increase, the incidence of EA surpassed that of squamous cell carcinoma. EA typically follows a well-established stepwise evolution from chronic inflammation due to reflux esophagitis (RE) that progresses to metaplasia (Barrett’s esophagus- BE) to dysplasia, which often culminates in EA. The pathophysiology of EA is complex and involves diverse factors, including gastroesophageal reflux, gastric acid secretion, dysfunction of the antireflux barrier, gastric emptying disturbances, and abnormalities in esophageal defense mechanisms. The current understanding of the etiology of EA is mainly derived from epidemiological studies of risk factors such as cigarette smoking, obesity, gastroesophageal reflux disorders (GERD), and low fruit and vegetable consumption. Numerous studies have been done but the factors that drive the dynamic increase in the incidence of EA remain elusive. The advent of widespread antibiotic use occurred in the 1950s, preceding the surge of EA. Based on this temporal sequence, it has been hypothesized that antibiotics alter the microbiome to which the esophagus is exposed in patients who have GERD and that chronic exposure to this abnormal microbiome (i.e., changes in species diversity or abundance) accounts for the increase in EA. If changes in the proposed factors alter the stepwise progression (RE-BE-dysplasia- EA), they may represent potential targets for chemoprevention. New discoveries will help improve our understanding of the biology and pathogenesis of these cancers, and aid in finding novel therapeutic targets.

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Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study

Abstract: RFA is an effective and durable treatment option for Barrett's-associated IMC. Greater than 80% of patients will achieve and maintain complete eradication of IMC at a mean of 2 years follow-up.

Cited by 24 publications

References 28 publications

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Endoscopic therapy for Barrett's oesophagus

Microbiome and potential targets for chemoprevention of esophageal adenocarcinoma

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