Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II).
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.


METHODS
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.


RESULTS
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.


BACKGROUND
NTR 1211, http://www.trialregister.nl.
Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.
K Nadine
KN
Phoa
Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.
Roos E
RE
Pouw
Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium.
Raf
R
Bisschops
Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany.
Oliver
O
Pech
Department of Gastroenterology, Queens Medical Centre, Nottingham, UK.
Krish
K
Ragunath
Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands.
Bas L A M
BL
Weusten
Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
Brigitte
B
Schumacher
Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK.
Bjorn
B
Rembacken
Department of Gastroenterology, Klinikum rechts der Isar, Munich, Germany.
Alexander
A
Meining
Department of Gastroenterology, Augsburg Hospital, Augsburg, Germany.
Helmut
H
Messmann
Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands.
Erik J
EJ
Schoon
Department of Internal Medicine II, Karlsruhe Hospital, Karlsruhe, Germany.
Liebwin
L
Gossner
Department of Gastroenterology, Queens Medical Centre, Nottingham, UK.
Jayan
J
Mannath
Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands.
C A
CA
Seldenrijk
Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.
Mike
M
Visser
Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium.
Toni
T
Lerut
Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Stefan
S
Seewald
Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.
Fiebo J
FJ
ten Kate
Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany.
Christian
C
Ell
Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
Horst
H
Neuhaus
Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands.
Jacques J G H M
JJ
Bergman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D017115:Catheter Ablation / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
BARRETT'S CARCINOMA; ENDOSCOPIC PROCEDURES; OESOPHAGEAL CANCER