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Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients.
Gut. 2010 Sep; 59(9):1169-77.Gut

Abstract

BACKGROUND AND AIMS

Endoscopic resection is safe and effective to remove early neoplasia (ie,high-grade intra-epithelial neoplasia/early cancer) in Barrett's oesophagus. To prevent metachronous lesions during follow-up, the remaining Barrett's oesophagus can be removed by stepwise radical endoscopic resection (SRER). The aim was to evaluate the combined experience in four tertiary referral centres with SRER to eradicate Barrett's oesophagus with early neoplasia.

DESIGN

Retrospective cohort study.

SETTING

Four tertiary referral centres.

PARTICIPANTS

169 patients (151 males, age 64 years (IQR 57-71), Barrett's oesophagus 3 cm (IQR 2-5)) with early neoplasia in Barrett's oesophagus < or = 5 cm, without deep submucosal infiltration or lymph node metastases, treated by SRER between January 2000 and September 2006.

INTERVENTION

Endoscopic resection every 4-8 weeks, until complete endoscopic and histological eradication of Barrett's oesophagus and neoplasia.

RESULTS

According to intention-to-treat analysis complete eradication of all neoplasia and all intestinal metaplasia by the end of the treatment phase was reached in 97.6% (165/169) and 85.2% (144/169) of patients, respectively. One patient had progression of neoplasia during treatment and died of metastasised adenocarcinoma (0.6%). After median follow-up of 32 months (IQR 19-49), complete eradication of neoplasia and intestinal metaplasia was sustained in 95.3% (161/169) and 80.5% (136/169) of patients, respectively. Acute, severe complications occurred in 1.2% of patients, and 49.7% of patients developed symptomatic stenosis.

CONCLUSIONS

SRER of Barrett's oesophagus < or = 5 cm containing early neoplasia appears to be an effective treatment modality with a low rate of recurrent lesions during follow-up. The procedure, however, is technically demanding and is associated with oesophageal stenosis in half of the patients.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.No 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)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

20525701

Citation

Pouw, Roos E., et al. "Stepwise Radical Endoscopic Resection for Eradication of Barrett's Oesophagus With Early Neoplasia in a Cohort of 169 Patients." Gut, vol. 59, no. 9, 2010, pp. 1169-77.
Pouw RE, Seewald S, Gondrie JJ, et al. Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients. Gut. 2010;59(9):1169-77.
Pouw, R. E., Seewald, S., Gondrie, J. J., Deprez, P. H., Piessevaux, H., Pohl, H., Rösch, T., Soehendra, N., & Bergman, J. J. (2010). Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients. Gut, 59(9), 1169-77. https://doi.org/10.1136/gut.2010.210229
Pouw RE, et al. Stepwise Radical Endoscopic Resection for Eradication of Barrett's Oesophagus With Early Neoplasia in a Cohort of 169 Patients. Gut. 2010;59(9):1169-77. PubMed PMID: 20525701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients. AU - Pouw,Roos E, AU - Seewald,Stefan, AU - Gondrie,Joep J, AU - Deprez,Pierre H, AU - Piessevaux,Hubert, AU - Pohl,Heiko, AU - Rösch,Thomas, AU - Soehendra,Nib, AU - Bergman,Jacques J, Y1 - 2010/06/04/ PY - 2010/6/8/entrez PY - 2010/6/8/pubmed PY - 2010/10/12/medline SP - 1169 EP - 77 JF - Gut JO - Gut VL - 59 IS - 9 N2 - BACKGROUND AND AIMS: Endoscopic resection is safe and effective to remove early neoplasia (ie,high-grade intra-epithelial neoplasia/early cancer) in Barrett's oesophagus. To prevent metachronous lesions during follow-up, the remaining Barrett's oesophagus can be removed by stepwise radical endoscopic resection (SRER). The aim was to evaluate the combined experience in four tertiary referral centres with SRER to eradicate Barrett's oesophagus with early neoplasia. DESIGN: Retrospective cohort study. SETTING: Four tertiary referral centres. PARTICIPANTS: 169 patients (151 males, age 64 years (IQR 57-71), Barrett's oesophagus 3 cm (IQR 2-5)) with early neoplasia in Barrett's oesophagus < or = 5 cm, without deep submucosal infiltration or lymph node metastases, treated by SRER between January 2000 and September 2006. INTERVENTION: Endoscopic resection every 4-8 weeks, until complete endoscopic and histological eradication of Barrett's oesophagus and neoplasia. RESULTS: According to intention-to-treat analysis complete eradication of all neoplasia and all intestinal metaplasia by the end of the treatment phase was reached in 97.6% (165/169) and 85.2% (144/169) of patients, respectively. One patient had progression of neoplasia during treatment and died of metastasised adenocarcinoma (0.6%). After median follow-up of 32 months (IQR 19-49), complete eradication of neoplasia and intestinal metaplasia was sustained in 95.3% (161/169) and 80.5% (136/169) of patients, respectively. Acute, severe complications occurred in 1.2% of patients, and 49.7% of patients developed symptomatic stenosis. CONCLUSIONS: SRER of Barrett's oesophagus < or = 5 cm containing early neoplasia appears to be an effective treatment modality with a low rate of recurrent lesions during follow-up. The procedure, however, is technically demanding and is associated with oesophageal stenosis in half of the patients. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/20525701/Stepwise_radical_endoscopic_resection_for_eradication_of_Barrett's_oesophagus_with_early_neoplasia_in_a_cohort_of_169_patients_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=20525701 DB - PRIME DP - Unbound Medicine ER -