title: Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.
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.
  
  
  METHODS
  Multicenter U.S. registry.
  
  
  METHODS
  Sixteen academic and community centers; treatment period from September 2004 to March 2007.
  
  
  METHODS
  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.
  
  
  METHODS
  Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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: Minnesota Gastroenterology, Plymouth, Minnesota 55446, USA.
authors: Robert A
authors: RA
authors: Ganz
authors: Bergein F
authors: BF
authors: Overholt
authors: Virender K
authors: VK
authors: Sharma
authors: David E
authors: DE
authors: Fleischer
authors: Nicholas J
authors: NJ
authors: Shaheen
authors: Charles J
authors: CJ
authors: Lightdale
authors: Stephen R
authors: SR
authors: Freeman
authors: Ronald E
authors: RE
authors: Pruitt
authors: Shiro M
authors: SM
authors: Urayama
authors: Frank
authors: F
authors: Gress
authors: Darren A
authors: DA
authors: Pavey
authors: M Stanley
authors: MS
authors: Branch
authors: Thomas J
authors: TJ
authors: Savides
authors: Kenneth J
authors: KJ
authors: Chang
authors: V Raman
authors: VR
authors: Muthusamy
authors: Anthony G
authors: AG
authors: Bohorfoush
authors: Samuel C
authors: SC
authors: Pace
authors: Steven R
authors: SR
authors: DeMeester
authors: Viktor E
authors: VE
authors: Eysselein
authors: Masoud
authors: M
authors: Panjehpour
authors: George
authors: G
authors: Triadafilopoulos
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery*; D001707:Biopsy, Needle; D017115:Catheter Ablation / Q000379:methods*; D004502:Education, Medical, Continuing; D004938:Esophageal Neoplasms / Q000473:pathology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States