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Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus

The latest issue of Gastroenterology investigates the use of radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma.

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Patients with Barrett's esophagus and high-grade dysplasia or early neoplasia increasingly receive endoscopic mucosal resection and radiofrequency ablation therapy.

Dr Rehan Haidry and colleagues from the United Kingdom analyzed data from a UK registry that follows the outcomes of patients with Barrett's Esophagus who have undergone resection and radiofrequency ablation for neoplasia.

The research team reported that they collected data on 335 patients with Barrett's esophagus and neoplasia, treated at 19 centers in the United Kingdom from 2008 through 2012.

Mean length of Barrett's esophagus segments was 5.8 cm.

Patients' nodules were removed by endoscopic mucosal resection, and the patients then underwent resection and radiofrequency ablation every 3 months until all areas of Barrett's esophagus were ablated or cancer developed.

The research team collected biopsies for 12 months after the first resection and radiofrequency ablation; clearance of high-grade dysplasia, dysplasia, and Barrett's esophagus were assessed

Symptomatic strictures developed in 9% of patients
Gastroenterology

High-grade dysplasia was cleared from 86% of patients, all dysplasia from 81%, and Barrett's esophagus from 62% at the 12-month time point, after a mean of 2.5 resection and radiofrequency ablation procedures.

The doctors noted that complete reversal dysplasia was 15% less likely for every 1-cm increment in Barrett's esophagus length.

Endoscopic mucosal resection before resection and radiofrequency ablation did not provide any benefit.

Invasive cancer developed in 10 patients by the 12-month time point and disease had progressed in 17 patients after a median follow-up time of 19 months.

The doctors found that symptomatic strictures developed in 9% of patients and were treated by endoscopic dilatation.

The team observed that 19 months after therapy began, 94% of patients remained clear of dysplasia.

Dr Haidry's team commented, "We analyzed data from a large series of patients in the United Kingdom who underwent resection and radiofrequency ablation for Barrett's esophagus-related neoplasia and found that by 12 months after treatment, dysplasia was cleared from 81%. "

"Shorter segments of Barrett's esophagus respond better to resection and radiofrequency ablation."

Gastroenterol 2013: 145(1) 87-95
15 July 2013

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