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A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system).
Endoscopy. 2008 May; 40(5):380-7.E

Abstract

BACKGROUND AND STUDY AIMS

Yearly surveillance endoscopy is carried out for Barrett's esophagus with low-grade dysplasia (LGD) so that progression to high-grade dysplasia and adenocarcinoma can be detected at the earliest stage. The aim of the study was to assess the long-term safety and effectiveness of circumferential ablation followed by focal ablation (HALO system) for eliminating Barrett's esophagus and LGD.

PATIENTS AND METHODS

Patients with 2 - 6 cm of Barrett's esophagus with histology demonstrating LGD on their last two sequential endoscopies over the previous 2 years and confirmed by two pathologists were enrolled in this prospective, single-center trial. Circumferential ablation was carried out at baseline and at 4 months (if residual Barrett's esophagus present). Endoscopy with 4-quadrant biopsies every 1 cm was performed at 1, 3, 6, 12, and 24 months. After 1 year, focal ablation was applied to any visible Barrett's esophagus or irregularity of the squamocolumnar junction. Patients received lansoprazole 30 mg bid. Complete responses for dysplasia (CR-dysplasia) and intestinal metaplasia (CR-IM) at 2-year follow-up, with complete response defined as "all biopsies negative for dysplasia or intestinal metaplasia" were the main outcomes.

RESULTS

Ten patients (nine men, mean age 66.9 years, range 48 - 79) with confirmed LGD (median 4.4 cm, range 3 - 6) underwent circumferential ablation with focal ablation after 1 year as necessary. At 2 years, CR-dysplasia was 100 % and CR-IM was 90 %. There were no strictures or buried intestinal metaplasia at follow-up.

CONCLUSION

A stepwise regimen of circumferential ablation followed by focal ablation appears to eradicate intestinal metaplasia (90 % CR-IM) and dysplasia (100 % CR-dysplasia) at 2-year follow-up in this trial, without stricture formation or buried intestinal metaplasia.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona 85253, USA. sharma.virender@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18459074

Citation

Sharma, V K., et al. "A Prospective Pilot Trial of Ablation of Barrett's Esophagus With Low-grade Dysplasia Using Stepwise Circumferential and Focal Ablation (HALO System)." Endoscopy, vol. 40, no. 5, 2008, pp. 380-7.
Sharma VK, Kim HJ, Das A, et al. A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). Endoscopy. 2008;40(5):380-7.
Sharma, V. K., Kim, H. J., Das, A., Dean, P., DePetris, G., & Fleischer, D. E. (2008). A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). Endoscopy, 40(5), 380-7. https://doi.org/10.1055/s-2007-995587
Sharma VK, et al. A Prospective Pilot Trial of Ablation of Barrett's Esophagus With Low-grade Dysplasia Using Stepwise Circumferential and Focal Ablation (HALO System). Endoscopy. 2008;40(5):380-7. PubMed PMID: 18459074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). AU - Sharma,V K, AU - Kim,H Jae, AU - Das,A, AU - Dean,P, AU - DePetris,G, AU - Fleischer,D E, PY - 2008/5/7/pubmed PY - 2008/7/30/medline PY - 2008/5/7/entrez SP - 380 EP - 7 JF - Endoscopy JO - Endoscopy VL - 40 IS - 5 N2 - BACKGROUND AND STUDY AIMS: Yearly surveillance endoscopy is carried out for Barrett's esophagus with low-grade dysplasia (LGD) so that progression to high-grade dysplasia and adenocarcinoma can be detected at the earliest stage. The aim of the study was to assess the long-term safety and effectiveness of circumferential ablation followed by focal ablation (HALO system) for eliminating Barrett's esophagus and LGD. PATIENTS AND METHODS: Patients with 2 - 6 cm of Barrett's esophagus with histology demonstrating LGD on their last two sequential endoscopies over the previous 2 years and confirmed by two pathologists were enrolled in this prospective, single-center trial. Circumferential ablation was carried out at baseline and at 4 months (if residual Barrett's esophagus present). Endoscopy with 4-quadrant biopsies every 1 cm was performed at 1, 3, 6, 12, and 24 months. After 1 year, focal ablation was applied to any visible Barrett's esophagus or irregularity of the squamocolumnar junction. Patients received lansoprazole 30 mg bid. Complete responses for dysplasia (CR-dysplasia) and intestinal metaplasia (CR-IM) at 2-year follow-up, with complete response defined as "all biopsies negative for dysplasia or intestinal metaplasia" were the main outcomes. RESULTS: Ten patients (nine men, mean age 66.9 years, range 48 - 79) with confirmed LGD (median 4.4 cm, range 3 - 6) underwent circumferential ablation with focal ablation after 1 year as necessary. At 2 years, CR-dysplasia was 100 % and CR-IM was 90 %. There were no strictures or buried intestinal metaplasia at follow-up. CONCLUSION: A stepwise regimen of circumferential ablation followed by focal ablation appears to eradicate intestinal metaplasia (90 % CR-IM) and dysplasia (100 % CR-dysplasia) at 2-year follow-up in this trial, without stricture formation or buried intestinal metaplasia. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/18459074/A_prospective_pilot_trial_of_ablation_of_Barrett's_esophagus_with_low_grade_dysplasia_using_stepwise_circumferential_and_focal_ablation__HALO_system__ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-995587 DB - PRIME DP - Unbound Medicine ER -