Durability of Radiofrequency Ablation in Barrett's Esophagus With Dysplasia

被引：358

作者：

Shaheen, Nicholas J. ^{[1
]}

Overholt, Bergein F. ^{[2
]}

Sampliner, Richard E. ^{[3
]}

Wolfsen, Herbert C. ^{[4
]}

Wang, Kenneth K. ^{[5
]}

Fleischer, David E. ^{[6
]}

Sharma, Virender K. ^{[7
]}

Eisen, Glenn M. ^{[8
]}

Fennerty, M. Brian ^{[8
]}

Hunter, John G. ^{[8
]}

Bronner, Mary P. ^{[9
]}

Goldblum, John R. ^{[10
]}

Bennett, Ana E. ^{[10
]}

Mashimo, Hiroshi ^{[11
]}

Rothstein, Richard I. ^{[12
]}

Gordon, Stuart R. ^{[12
]}

Edmundowicz, Steven A. ^{[13
]}

Madanick, Ryan D. ^{[1
]}

Peery, Anne F. ^{[1
]}

Muthusamy, V. Raman ^{[14
]}

Chang, Kenneth J. ^{[14
]}

Kimmey, Michael B. ^{[15
]}

Spechler, Stuart J. ^{[16
]}

Siddiqui, Ali A. ^{[17
]}

Souza, Rhonda F. ^{[16
]}

Infantolino, Anthony ^{[17
]}

Dumot, John A. ^{[18
]}

Falk, Gary W. ^{[19
]}

Galanko, Joseph A. ^{[1
]}

Jobe, Blair A. ^{[20
]}

Hawes, Robert H. ^{[21
]}

Hoffman, Brenda J. ^{[21
]}

Sharma, Prateek ^{[22
,23
]}

Chak, Amitabh ^{[18
]}

Lightdale, Charles J. ^{[24
]}

机构：

[1] Univ N Carolina, Sch Med, Ctr Esophageal Dis & Swallowing, Chapel Hill, NC 27599 USA

[2] Gastrointestinal Associates, Knoxville, TN USA

[3] Univ Arizona, Ctr Canc, Tucson, AZ USA

[4] Mayo Clin Florida, Jacksonville, FL USA

[5] Mayo Clin Rochester, Rochester, MN USA

[6] Mayo Clin Arizona, Scottsdale, AZ USA

[7] Arizona Ctr Digest Hlth, Gilbert, AZ USA

[8] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[9] Univ Utah, Salt Lake City, UT USA

[10] Cleveland Clin, Cleveland, OH 44106 USA

[11] VA Boston Healthcare Syst, W Roxbury, MA USA

[12] Dartmouth Hitchcock Med Ctr, Lebanon, NH 03766 USA

[13] Washington Univ, Med Ctr, St Louis, MO USA

[14] Univ Calif Irvine, Orange, CA 92668 USA

[15] Tacoma Digest Dis Res Ctr LLC, Tacoma, WA USA

[16] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

[17] Thomas Jefferson Univ, Philadelphia, PA 19107 USA

[18] Univ Hosp Case Med Ctr, Cleveland, OH USA

[19] Univ Penn, Philadelphia, PA 19104 USA

[20] Univ Pittsburgh, Pittsburgh, PA USA

[21] Med Univ S Carolina, Charleston, SC 29425 USA

[22] VA Med Ctr, Kansas City, MO USA

[23] Univ Kansas, Sch Med, Kansas City, MO USA

[24] Columbia Univ, Med Ctr, New York, NY USA

来源：

GASTROENTEROLOGY | 2011年 / 141卷 / 02期

关键词：

Esophagus; Cancer; Prevention; Endoscopic Therapy; HIGH-GRADE DYSPLASIA; PUMP INHIBITOR USE; FOCAL ABLATION; ACQUIRED PNEUMONIA; RISK; NEOPLASIA; OUTCOMES; THERAPY; DIAGNOSIS; REGISTRY;

D O I：

10.1053/j.gastro.2011.04.061

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND & AIMS: Radiofrequency ablation (RFA) can eradicate dysplasia and intestinal metaplasia in patients with dysplastic Barrett's esophagus (BE), and reduce rates of esophageal adenocarcinoma. We assessed long-term rates of eradication, durability of neosquamous epithelium, disease progression, and safety of RFA in patients with dysplastic BE. METHODS: We performed a randomized trial of 127 subjects with dysplastic BE; after crossover subjects were included, 119 received RFA. Subjects were followed for a mean time of 3.05 years; the study was extended to 5 years for patients with eradication of intestinal metaplasia at 2 years. Outcomes included eradication of dysplasia or intestinal metaplasia after 2 and 3 years, durability of response, disease progression, and adverse events. RESULTS: After 2 years, 101 of 106 patients had complete eradication of all dysplasia (95%) and 99 of 106 had eradication of intestinal metaplasia (93%). After 2 years, among subjects with initial low-grade dysplasia, all dysplasia was eradicated in 51 of 52 (98%) and intestinal metaplasia was eradicated in 51 of 52 (98%); among subjects with initial high-grade dysplasia, all dysplasia was eradicated in 50 of 54 (93%) and intestinal metaplasia was eradicated in 48 of 54 (89%). After 3 years, dysplasia was eradicated in 55 of 56 of subjects (98%) and intestinal metaplasia was eradicated in 51 of 56 (91%). Kaplan-Meier analysis showed that dysplasia remained eradicated in >85% of patients and intestinal metaplasia in >75%, without maintenance RFA. Serious adverse events occurred in 4 of 119 subjects (3.4%); the rate of stricture was 7.6%. The rate of esophageal adenocarcinoma was 1 per 181 patient-years (0.55%/patient-years); there was no cancer-related morbidity or mortality. The annual rate of any neoplastic progression was 1 per 73 patient-years (1.37%/patient-years). CONCLUSIONS: In subjects with dysplastic BE, RFA therapy has an acceptable safety profile, is durable, and is associated with a low rate of disease progression, for up to 3 years.

引用

页码：460 / 468

页数：9

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