Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia

Phoa, K. Nadine; Vilsteren, Frederike G.I. van; Weusten, Bas L.; Bisschops, Raf; Schoon, Erik J.; Ragunath, Krish; Fullarton, Grant; Pietro, Massimiliano di; Ravi, Narayanasamy; Visser, Mike; Offerhaus, G. J. A.; Seldenrijk, Cees A.; Meijer, Sybren L.; Kate, Fiebo J.W. ten; Tijssen, Jan G.P.; Bergman, Jacques

doi:10.1001/jama.2014.2511

Cited by 566 publications

(541 citation statements)

References 32 publications

(57 reference statements)

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“…However, unlike the case with PPIs, the side-eff ect profi le of ASA is not benign, and adverse events including cerebral and GI hemorrhage may be catastrophic. Also, given recent level 1 evidence demonstrating markedly diminished cancer risk in subjects with LGD undergoing endoscopic therapy ( 142 ), it is likely that more patients with confi rmed LGD will undergo this therapy, as opposed to surveillance endoscopy. If so, these patients will likely not need chemoprevention.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…In patients with BE and HGD, ablative therapy should be preferred over either esophagectomy or intensive endoscopic surveillance because of its proven effi cacy ( 63 ) and a side-eff ect profi le superior to surgery ( 147 ). Recent data demonstrate that in patients with BE and LGD confi rmed by a second pathologist, ablative therapy results in a statistically and clinically signifi cant reduction in progression to the combined end point of HGD or EAC, or to EAC alone ( 142 ). In contrast, in patients with nondysplastic BE, recent data suggest lower rates of progression are associated with high rates of lymphatic involvement ( 154,158 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Currently, level 1 evidence for prevention of cancer incidence exists in three clinical scenarios: photodynamic therapy in the setting of BE with HGD, radiofrequency ablation in the setting of HGD, and radiofrequency ablation in the setting of LGD ( 63,142,166 ). Given the costs and side-eff ect profi le of photodynamic therapy, as well as the large body of data supporting the safety and effi cacy of radiofrequency ablation, this modality appears to be the preferred therapy for most patients.…”

Section: Summary Of Evidencementioning

confidence: 99%

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ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

1,412

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“…Since a diagnosis of LGD is now a clinical indication for endoscopic ablation therapy, following evidence for the superiority of ablation therapy compared with surveillance, 13 it is impossible to assess the patients' natural history.…”

Section: Low Grade Dysplasia (Lgd) Is a Difficult Histopathological Dmentioning

confidence: 99%

Risk stratification of Barrett's oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study

Ross-Innes

Chettouh

Achilleos

et al. 2017

The Lancet Gastroenterology & Hepatology

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“…Radiofrequency ablation (RFA) has been shown to be a good option for the treatment of patients with LGD and HGD with low rate of complications and good cost-effective results (58). Moreover, the use of RFA for the treatment of patients with confirmed LGD has shown a significant reduction in progression to HGD and EAC in one randomized trial (59).…”

Section: Management and Treatment Of Bementioning

confidence: 99%