Circumferential Ablation of Barrett's Esophagus That Contains High-Grade Dysplasia: A U.S. Multicenter Registry

Gastrointest Endosc. 2008 Jul;68(1):35-40. doi: 10.1016/j.gie.2007.12.015. Epub 2008 Mar 19.

Abstract

Background: The management strategies for Barrett's esophagus (BE) that contains high-grade dysplasia (HGD) include intensive endoscopic surveillance, photodynamic therapy, thermal ablation, EMR, and esophagectomy.

Objective: To assess the safety and effectiveness of endoscopic circumferential balloon-based ablation by using radiofrequency energy for treating BE HGD.

Design: Multicenter U.S. registry.

Setting: Sixteen academic and community centers; treatment period from September 2004 to March 2007.

Patients: Patients with histologic evidence of intestinal metaplasia (IM) that contained HGD confirmed by at least 2 expert pathologists. A prior EMR was permitted, provided that residual HGD remained in the BE region for ablation.

Intervention: Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment.

Outcomes: Histologic complete response (CR) end points: (1) all biopsy specimen fragments obtained at the last biopsy session were negative for HGD (CR-HGD), (2) all biopsy specimens were negative for any dysplasia (CR-D), and (3) all biopsy specimens were negative for IM (CR-IM).

Results: A total of 142 patients (median age 66 years, interquartile range [IQR] 59-75 years) who had BE HGD (median length 6 cm, IQR 3-8 cm) underwent circumferential ablation (median 1 session, IQR 1-2). No serious adverse events were reported. There was 1 asymptomatic stricture and no buried glands. Ninety-two patients had at least 1 follow-up biopsy session (median follow-up 12 months, IQR 8-15 months). A CR-HGD was achieved in 90.2% of patients, CR-D in 80.4%, and CR-IM in 54.3%.

Limitations: A nonrandomized study design, without a control arm, a lack of centralized pathology review, ablation and biopsy technique not standardized, and a relatively short-term follow-up.

Conclusions: Endoscopic circumferential ablation is a promising modality for the treatment of BE that contains HGD. In this multicenter registry, the intervention safely achieved a CR for HGD in 90.2% of patients at a median of 12 months of follow-up.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Barrett Esophagus / pathology*
  • Barrett Esophagus / surgery*
  • Biopsy, Needle
  • Catheter Ablation / methods*
  • Education, Medical, Continuing
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / prevention & control*
  • Esophagoscopy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Precancerous Conditions / pathology*
  • Precancerous Conditions / surgery
  • Registries
  • Risk Assessment
  • Sensitivity and Specificity
  • Treatment Outcome
  • United States