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Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II).
Gut. 2016 Apr; 65(4):555-62.Gut

Abstract

OBJECTIVE

Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.

DESIGN

In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter.

OUTCOMES

complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.

RESULTS

132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.

CONCLUSIONS

In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.

TRIAL REGISTRATION NUMBER

NTR 1211, http://www.trialregister.nl.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium.Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany.Department of Gastroenterology, Queens Medical Centre, Nottingham, UK.Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands.Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK.Department of Gastroenterology, Klinikum rechts der Isar, Munich, Germany.Department of Gastroenterology, Augsburg Hospital, Augsburg, Germany.Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands.Department of Internal Medicine II, Karlsruhe Hospital, Karlsruhe, Germany.Department of Gastroenterology, Queens Medical Centre, Nottingham, UK.Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands.Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium.Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany.Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25731874

Citation

Phoa, K Nadine, et al. "Multimodality Endoscopic Eradication for Neoplastic Barrett Oesophagus: Results of an European Multicentre Study (EURO-II)." Gut, vol. 65, no. 4, 2016, pp. 555-62.
Phoa KN, Pouw RE, Bisschops R, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut. 2016;65(4):555-62.
Phoa, K. N., Pouw, R. E., Bisschops, R., Pech, O., Ragunath, K., Weusten, B. L., Schumacher, B., Rembacken, B., Meining, A., Messmann, H., Schoon, E. J., Gossner, L., Mannath, J., Seldenrijk, C. A., Visser, M., Lerut, T., Seewald, S., ten Kate, F. J., Ell, C., ... Bergman, J. J. (2016). Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut, 65(4), 555-62. https://doi.org/10.1136/gutjnl-2015-309298
Phoa KN, et al. Multimodality Endoscopic Eradication for Neoplastic Barrett Oesophagus: Results of an European Multicentre Study (EURO-II). Gut. 2016;65(4):555-62. PubMed PMID: 25731874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). AU - Phoa,K Nadine, AU - Pouw,Roos E, AU - Bisschops,Raf, AU - Pech,Oliver, AU - Ragunath,Krish, AU - Weusten,Bas L A M, AU - Schumacher,Brigitte, AU - Rembacken,Bjorn, AU - Meining,Alexander, AU - Messmann,Helmut, AU - Schoon,Erik J, AU - Gossner,Liebwin, AU - Mannath,Jayan, AU - Seldenrijk,C A, AU - Visser,Mike, AU - Lerut,Toni, AU - Seewald,Stefan, AU - ten Kate,Fiebo J, AU - Ell,Christian, AU - Neuhaus,Horst, AU - Bergman,Jacques J G H M, Y1 - 2015/03/02/ PY - 2015/02/01/received PY - 2015/02/07/accepted PY - 2015/3/4/entrez PY - 2015/3/4/pubmed PY - 2016/7/19/medline KW - BARRETT'S CARCINOMA KW - ENDOSCOPIC PROCEDURES KW - OESOPHAGEAL CANCER SP - 555 EP - 62 JF - Gut JO - Gut VL - 65 IS - 4 N2 - OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study. DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter. OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review. RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically. CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up. TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/25731874/Multimodality_endoscopic_eradication_for_neoplastic_Barrett_oesophagus:_results_of_an_European_multicentre_study__EURO_II__ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=25731874 DB - PRIME DP - Unbound Medicine ER -