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Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.
Gastrointest Endosc. 2008 Jul; 68(1):35-40.GE

Abstract

BACKGROUND

The management strategies for Barrett's esophagus (BE) that contains high-grade dysplasia (HGD) include intensive endoscopic surveillance, photodynamic therapy, thermal ablation, EMR, and esophagectomy.

OBJECTIVE

To assess the safety and effectiveness of endoscopic circumferential balloon-based ablation by using radiofrequency energy for treating BE HGD.

DESIGN

Multicenter U.S. registry.

SETTING

Sixteen academic and community centers; treatment period from September 2004 to March 2007.

PATIENTS

Patients with histologic evidence of intestinal metaplasia (IM) that contained HGD confirmed by at least 2 expert pathologists. A prior EMR was permitted, provided that residual HGD remained in the BE region for ablation.

INTERVENTION

Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment.

OUTCOMES

Histologic complete response (CR) end points: (1) all biopsy specimen fragments obtained at the last biopsy session were negative for HGD (CR-HGD), (2) all biopsy specimens were negative for any dysplasia (CR-D), and (3) all biopsy specimens were negative for IM (CR-IM).

RESULTS

A total of 142 patients (median age 66 years, interquartile range [IQR] 59-75 years) who had BE HGD (median length 6 cm, IQR 3-8 cm) underwent circumferential ablation (median 1 session, IQR 1-2). No serious adverse events were reported. There was 1 asymptomatic stricture and no buried glands. Ninety-two patients had at least 1 follow-up biopsy session (median follow-up 12 months, IQR 8-15 months). A CR-HGD was achieved in 90.2% of patients, CR-D in 80.4%, and CR-IM in 54.3%.

LIMITATIONS

A nonrandomized study design, without a control arm, a lack of centralized pathology review, ablation and biopsy technique not standardized, and a relatively short-term follow-up.

CONCLUSIONS

Endoscopic circumferential ablation is a promising modality for the treatment of BE that contains HGD. In this multicenter registry, the intervention safely achieved a CR for HGD in 90.2% of patients at a median of 12 months of follow-up.

Authors+Show Affiliations

Minnesota Gastroenterology, Plymouth, Minnesota 55446, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18355819

Citation

Ganz, Robert A., et al. "Circumferential Ablation of Barrett's Esophagus That Contains High-grade Dysplasia: a U.S. Multicenter Registry." Gastrointestinal Endoscopy, vol. 68, no. 1, 2008, pp. 35-40.
Ganz RA, Overholt BF, Sharma VK, et al. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008;68(1):35-40.
Ganz, R. A., Overholt, B. F., Sharma, V. K., Fleischer, D. E., Shaheen, N. J., Lightdale, C. J., Freeman, S. R., Pruitt, R. E., Urayama, S. M., Gress, F., Pavey, D. A., Branch, M. S., Savides, T. J., Chang, K. J., Muthusamy, V. R., Bohorfoush, A. G., Pace, S. C., DeMeester, S. R., Eysselein, V. E., ... Triadafilopoulos, G. (2008). Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointestinal Endoscopy, 68(1), 35-40. https://doi.org/10.1016/j.gie.2007.12.015
Ganz RA, et al. Circumferential Ablation of Barrett's Esophagus That Contains High-grade Dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008;68(1):35-40. PubMed PMID: 18355819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. AU - Ganz,Robert A, AU - Overholt,Bergein F, AU - Sharma,Virender K, AU - Fleischer,David E, AU - Shaheen,Nicholas J, AU - Lightdale,Charles J, AU - Freeman,Stephen R, AU - Pruitt,Ronald E, AU - Urayama,Shiro M, AU - Gress,Frank, AU - Pavey,Darren A, AU - Branch,M Stanley, AU - Savides,Thomas J, AU - Chang,Kenneth J, AU - Muthusamy,V Raman, AU - Bohorfoush,Anthony G, AU - Pace,Samuel C, AU - DeMeester,Steven R, AU - Eysselein,Viktor E, AU - Panjehpour,Masoud, AU - Triadafilopoulos,George, AU - ,, Y1 - 2008/03/19/ PY - 2007/06/04/received PY - 2007/12/11/accepted PY - 2008/3/22/pubmed PY - 2008/8/30/medline PY - 2008/3/22/entrez SP - 35 EP - 40 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 68 IS - 1 N2 - BACKGROUND: The management strategies for Barrett's esophagus (BE) that contains high-grade dysplasia (HGD) include intensive endoscopic surveillance, photodynamic therapy, thermal ablation, EMR, and esophagectomy. OBJECTIVE: To assess the safety and effectiveness of endoscopic circumferential balloon-based ablation by using radiofrequency energy for treating BE HGD. DESIGN: Multicenter U.S. registry. SETTING: Sixteen academic and community centers; treatment period from September 2004 to March 2007. PATIENTS: Patients with histologic evidence of intestinal metaplasia (IM) that contained HGD confirmed by at least 2 expert pathologists. A prior EMR was permitted, provided that residual HGD remained in the BE region for ablation. INTERVENTION: Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment. OUTCOMES: Histologic complete response (CR) end points: (1) all biopsy specimen fragments obtained at the last biopsy session were negative for HGD (CR-HGD), (2) all biopsy specimens were negative for any dysplasia (CR-D), and (3) all biopsy specimens were negative for IM (CR-IM). RESULTS: A total of 142 patients (median age 66 years, interquartile range [IQR] 59-75 years) who had BE HGD (median length 6 cm, IQR 3-8 cm) underwent circumferential ablation (median 1 session, IQR 1-2). No serious adverse events were reported. There was 1 asymptomatic stricture and no buried glands. Ninety-two patients had at least 1 follow-up biopsy session (median follow-up 12 months, IQR 8-15 months). A CR-HGD was achieved in 90.2% of patients, CR-D in 80.4%, and CR-IM in 54.3%. LIMITATIONS: A nonrandomized study design, without a control arm, a lack of centralized pathology review, ablation and biopsy technique not standardized, and a relatively short-term follow-up. CONCLUSIONS: Endoscopic circumferential ablation is a promising modality for the treatment of BE that contains HGD. In this multicenter registry, the intervention safely achieved a CR for HGD in 90.2% of patients at a median of 12 months of follow-up. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/18355819/Circumferential_ablation_of_Barrett's_esophagus_that_contains_high_grade_dysplasia:_a_U_S__Multicenter_Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)03276-2 DB - PRIME DP - Unbound Medicine ER -