Radiofrequency ablation is effective for the treatment of high-grade dysplasia in Barrett’s esophagus after failed photodynamic therapy

Dunn, Jason M.; Banks, Matthew; Oukrif, Dahmane; Mackenzie, Gary D.; Thorpe, Sally; Rodriguez‐Justo, Manuel; Winstanley, Alison; Bown, Stephen G.; Novelli, M; Lovat, Laurence

doi:10.1055/s-0030-1256443

Cited by 15 publications

(7 citation statements)

References 11 publications

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“…Safety and tolerability were superior, with a decreased number of therapeutic sessions in the RFA group (Evidence grade Ib). RFA has not been compared with PDT, but patients with failed PDT have been successfully treated with RFA 278. PDT has a significant photosensitivity and stricture rate, therefore RFA appears to have a better safety profile and is easier to administer.…”

Section: Management Of Dysplasia and Early Cancermentioning

confidence: 99%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,163

1,318

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These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

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Section: Management Of Dysplasia and Early Cancermentioning

confidence: 99%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,163

1,318

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“…Another endoscopic technique called radiofrequency ablation (RFA) appears to be equally effective to PDT for elimination of high grade dysplasia, and because RFA does not require any additional drug, may be gaining favor among clinicians [71]. However, both PDT and RFA represent good alternatives to esophagectomy.…”

Section: Pdt For Esophageal Cancer and Precancer (Barrett's)mentioning

confidence: 99%

Biomodulatory approaches to photodynamic therapy for solid tumors

Anand¹,

Ortel²,

Pereira³

et al. 2012

Cancer Letters

143

153

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Photodynamic Therapy (PDT) uses a photosensitizing drug in combination with visible light to kill cancer cells. PDT has an advantage over surgery or ionizing radiation because PDT can eliminate tumors without causing fibrosis or scarring. Disadvantages include the dual need for drug and light, and a generally lower efficacy for PDT versus surgery. This minireview describes basic principles of PDT, photosensitizers available, and aspects of tumor biology that may provide further opportunities for treatment optimization. An emerging biomodulatory approach, using methotrexate or Vitamin D in combination with aminolevulinate-based PDT, is described. Finally, current clinical uses of PDT for solid malignancies are reviewed.

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“…SSIM has been reported less frequently after RFA than after PDT [12]. The Netherlands cohort study detected SSIM in 6% of patients (3/54) and our previous study, in patients with failed PDT and subsequent RFA, confirmed buried glands in 7% of patients (1/14) [22,23].…”

Section: Discussionmentioning

confidence: 73%

Esophageal neoplasia arising from subsquamous buried glands after an apparently successful photodynamic therapy or radiofrequency ablation for Barrett’s associated neoplasia

Kohoutová

Haidry

Banks

et al. 2015

Scandinavian Journal of Gastroenterology

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Radiofrequency ablation is effective for the treatment of high-grade dysplasia in Barrett’s esophagus after failed photodynamic therapy

Cited by 15 publications

References 11 publications

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Biomodulatory approaches to photodynamic therapy for solid tumors

Esophageal neoplasia arising from subsquamous buried glands after an apparently successful photodynamic therapy or radiofrequency ablation for Barrett’s associated neoplasia

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