title: Comparison of endoscopic treatment modalities for Barrett's neoplasia.
abstract: BACKGROUND
  There are few data comparing endoscopic treatment outcomes for Barrett's esophagus (BE).
  
  
  OBJECTIVE
  To compare treatment outcomes in BE patients treated with radiofrequency ablation (RFA), RFA after EMR, and porfimer sodium photodynamic therapy (Ps-PDT).
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Single tertiary center between 2001 and 2013.
  
  
  METHODS
  A total of 342 BE patients treated with RFA (n = 119), EMR+RFA (n = 98), and Ps-PDT (n = 125).
  
  
  METHODS
  Rates of complete remission of intestinal metaplasia (CRIM), BE recurrence, and adverse events.
  
  
  RESULTS
  Baseline BE high-grade dysplasia (HGD) and adenocarcinoma were more common in the Ps-PDT group (89%) compared with the EMR-RFA (70%) and RFA (37%) groups. At a median follow-up of 14.2 months, 173 patients (50.6%) achieved CRIM. CRIM was significantly more common in Ps-PDT patients compared with RFA (P < .001) and EMR-RFA (P < .001) patients on multivariable analysis. In patients who achieved CRIM, the rates of subsequent BE recurrence were relatively similar among the 3 groups. Although the rates of bleeding were similar, strictures were less common in RFA patients (2.4%) compared with EMR-RFA (13.3%, P = .001) and Ps-PDT (10.4%, P =.043) patients.
  
  
  CONCLUSIONS
  This study of endoscopic treatment for Barrett's dysplasia and neoplasia found that complete remission was achieved more often and more rapidly after Ps-PDT with similar disease recurrence rates compared with EMR or RFA. Adverse events were more common after EMR and Ps-PDT. Further studies are required to determine which ablation and resection techniques are ideally suited for each BE patient.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Waseem J
authors.initials: WJ
authors.lastname: David
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; Florida State University, Archbold Medical Group, Thomasville, Georgia, USA.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Yazen
authors.initials: Y
authors.lastname: Qumsiyeh
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether