Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.
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.
Ganz
Robert A
RA
Minnesota Gastroenterology, Plymouth, Minnesota 55446, USA.
Overholt
Bergein F
BF
Sharma
Virender K
VK
Fleischer
David E
DE
Shaheen
Nicholas J
NJ
Lightdale
Charles J
CJ
Freeman
Stephen R
SR
Pruitt
Ronald E
RE
Urayama
Shiro M
SM
Gress
Frank
F
Pavey
Darren A
DA
Branch
M Stanley
MS
Savides
Thomas J
TJ
Chang
Kenneth J
KJ
Muthusamy
V Raman
VR
Bohorfoush
Anthony G
AG
Pace
Samuel C
SC
DeMeester
Steven R
SR
Eysselein
Viktor E
VE
Panjehpour
Masoud
M
Triadafilopoulos
George
G
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