Comparison of endoscopic treatment modalities for Barrett鈥檚 neoplasia

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• 作者：Waseem J. David ; MD¹ ; Bashar J. Qumseya ; MD¹ ; ² ; Yazen Qumsiyeh ; MD¹ ; ³ ; Michael G. Heckman ; MS⁴ ; Nancy N. Diehl ; BS⁴ ; Michael B. Wallace ; MD ; MPH¹ ; Massimo Raimondo ; MD¹ ; Timothy A. Woodward ; MD¹ ; Herbert C. Wolfsen ; MD¹ ;
• 关键词：BE ; Barrett&rsquo ; s esophagus ; CI ; confidence interval ; CRIM ; complete remission of intestinal metaplasia ; HGD ; high-grade dysplasia ; Ps-PDT ; porfimer sodium photodynamic therapy ; RFA ; radiofrequency ablation ; RR ; relative risk
• 刊名：Gastrointestinal Endoscopy
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：82
• 期：5
• 页码：793-803.e3
• 全文大小：1068 K

文摘

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).

Design

Retrospective, observational study.

Setting

Single tertiary center between 2001 and 2013.

Patients

A total of 342 BE patients treated with RFA (n = 119), EMR+RFA (n = 98), and Ps-PDT (n = 125).

Main Outcome Measurements

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.

Conclusion

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.