nach oben

Current Treatment Options in Gastroenterology

Erschienen in:

10.05.2019 | Endoscopy (P Siersema, Section Editor)

Durability of Endoscopic Treatment for Dysplastic Barrett’s Esophagus

verfasst von: Craig C. Reed, MD, MSCR, Nicholas J. Shaheen, MD, MPH

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

This review discusses the durability of the neo-squamous esophageal epithelium following endoscopic eradication therapy of dysplastic Barrett’s esophagus. Our review will focus primarily on patients treated with radiofrequency ablation; however, we describe the known durability of cryotherapy. Additionally, we discuss the utility of novel imaging technologies and the efficacy of chemopreventive medications following endoscopic ablation.

Recent findings

Mounting data describe the durability of the post-ablation esophagus. Dysplastic Barrett’s esophagus and adenocarcinoma following ablation are rare. New data emphasize that most recurrent disease occurs in the initial year following treatment. Additionally, recent publications suggest that a much-attenuated surveillance interval may provide adequate detection of neoplasia with many fewer surveillance endoscopies.

Summary

Future guidelines will likely liberalize surveillance intervals following endoscopic eradication therapy. Additionally, further longitudinal studies will need to assess the length of time for which surveillance is indicated. The utility of chemopreventive strategies and adjunctive imaging modalities in the maintenance and surveillance of the post-ablation esophagus also remain unclear and will be areas for future investigation.

• Shaheen NJ, Falk GW, Iyer PG, Gerson L. ACG clinical guideline: diagnosis and Management of Barrett’s esophagus. Am J Gastroenterol. 2015;108(8):1238–49 This paper contains current consensus guidelines for the management of Barrett's esophagus.

Ronkainen J, Aro P, Storskrubb T, Johansson S–E, Lind T, Bolling–Sternevald E, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129(6):1825–31.PubMed

Zagari RM, Fuccio L, Wallander M-A, Johansson S, Fiocca R, Casanova S, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: the Loiano-Monghidoro study. Gut. 2008;57(10):1354–9.PubMed

Johansson J, Håkansson H-O, Mellblom L, Kempas A, Johansson KE, Granath F, et al. Prevalence of precancerous and other metaplasia in the distal oesophagus and gastro-oesophageal junction. Scand J Gastroenterol. 2005;40(8):893–902.PubMed

Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.PubMed

Basu KK, Pick B, Bale R, West KP, de Caestecker JS. Efficacy and one year follow up of argon plasma coagulation therapy for ablation of Barrett’s oesophagus: factors determining persistence and recurrence of Barrett’s epithelium. Gut. 2002;51(6):776–80.PubMedPubMedCentral

Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.PubMed

Okoro NI, Tomizawa Y, Dunagan KT, Lutzke LS, Wang KK, Prasad GA. Safety of prior endoscopic mucosal resection in patients receiving radiofrequency ablation of Barrett’s esophagus. Clin Gastroenterol Hepatol. 2012;10(2):150–4.PubMed

Bulsiewicz WJ, Kim HP, Dellon ES, Cotton CC, Pasricha S, Madanick RD, et al. Safety and efficacy of endoscopic mucosal therapy with radiofrequency ablation for patients with neoplastic barrett’s esophagus. Clin Gastroenterol Hepatol. 2013;11(6):636–42.PubMed

10.

Sharma VK, Jae Kim H, Das A, Wells CD, Nguyen CC, Fleischer DE. Circumferential and focal ablation of Barrett’s esophagus containing dysplasia. Am J Gastroenterol. 2009;104(2):310–7.PubMed

11.

Pasricha S, Bulsiewicz WJ, Hathorn KE, Komanduri S, Muthusamy VR, Rothstein RI, et al. Durability and predictors of successful radiofrequency ablation for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2014;12(11):1840–1847.e1.PubMedPubMedCentral

12.

Gupta M, Iyer PG, Lutzke L, Gorospe EC, Abrams JA, Falk GW, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US multicenter consortium. Gastroenterology. 2013;145(1):79–86.PubMed

13.

Phoa KN, Pouw RE, Van Vilsteren FGI, et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology. 2013;145(1):96–104.PubMed

14.

Fuji-Lau L, Cinnor B, Shaheen N, et al. Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis. Endosc Int Open. 2017;5(6):E430–49.

15.

• Cotton CC, Haidry R, Thrift AP, Lovat L, Shaheen NJ. Development of evidence-based surveillance intervals after radiofrequency ablation of Barrett’s esophagus. Gastroenterology. 2018;155(2):316–326.e6 This study analyzed data from the US RFA and UK NHR to produce new recommendations for surveillance intervals in patients with BE and CEIM. They propose surveillance at 1 and 3 years after CEIM for LGD and surveillance at 0.25, 0.5, and 1 year after CEIM for HGD.PubMed

16.

Yasuda K, Choi SE, Nishioka NS, Rattner DW, Puricelli WP, Tramontano AC, et al. Incidence and predictors of adenocarcinoma following endoscopic ablation of Barrett’s esophagus. Dig Dis Sci. 2014;59(7):1560–6.PubMedPubMedCentral

17.

• Komanduri S, Kahrilas PJ, Krishnan K, McGorisk T, Bidari K, Grande D, et al. Recurrence of Barrett’s esophagus is rare following endoscopic eradication therapy coupled with effective reflux control. Am J Gastroenterol. 2017;112(4):556–66 The authors underscore the importance of reflux control in patients with BE who completed EET.PubMed

18.

Titi M, Overhiser A, Ulusarac O, Falk GW, Chak A, Wang K, et al. Development of subsquamous high-grade dysplasia and adenocarcinoma after successful radiofrequency ablation of Barrett’s esophagus. Gastroenterology. 2012;143(3):564–6.PubMed

19.

Anders M, Bähr C, El-Masry MA, et al. Long-term recurrence of neoplasia and Barrett’s epithelium after complete endoscopic resection. Gut. 2014;63(10):1535–43.PubMed

20.

Orman ES, Kim HP, Bulsiewicz WJ, Cotton CC, Dellon ES, Spacek MB, et al. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett’s esophagus with radiofrequency ablation. Am J Gastroenterol. 2013;108(2):187–95.PubMed

21.

Guthikonda A, Cotton CC, Madanick RD, Spacek MB, Moist SE, Ferrell K, et al. Clinical outcomes following recurrence of intestinal metaplasia after successful treatment of Barrett’s esophagus with radiofrequency ablation. Am J Gastroenterol. 2017;112(1):87–94.PubMed

22.

• Cotton CC, Wolf WA, Overholt BF, Li N, Lightdale CJ, Wolfsen HC, et al. Late recurrence of Barrett’s esophagus after complete eradication of intestinal metaplasia is rare: final report from ablation in intestinal metaplasia containing dysplasia trial. Gastroenterology. 2017;153(3):681–8 Here, the authors assessed data from the AIM Dypsplasia Trial to examine the proportion of patients with recurrence over time. This data suggest that the recurrent disease occurs disproportionately in the first year following CEIM.PubMed

23.

Gaddam S, Singh M, Balasubramanian G, Thota P, Gupta N, Wani S, et al. Persistence of nondysplastic Barrett’s esophagus identifies patients at lower risk for esophageal adenocarcinoma: results from a large multicenter cohort. Gastroenterology. 2013;145(3):548–53.PubMed

24.

Lee JK, Cameron RG, Binmoeller KF, Shah JN, Shergill A, Garcia-Kennedy R, et al. Recurrence of subsquamous dysplasia and carcinoma after successful endoscopic and radiofrequency ablation therapy for dysplastic Barrett’s esophagus. Endoscopy. 2013;45(7):571–4.PubMed

25.

Haidry RJ, Dunn JM, Butt MA, Burnell MG, Gupta A, Green S, et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett’s esophagus and early esophageal adenocarcinoma: outcomes of the UK national halo RFA registry. Gastroenterology. 2013;145(1):87–95.PubMed

26.

Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2011;106(11):1899–908 quiz 1909.PubMed

27.

Zhou C, Tsai TH, Lee HC, Kirtane T, Figueiredo M, Tao YK, et al. Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos). Gastrointest Endosc. 2012;76(1):32–40.PubMedPubMedCentral

28.

Phoa KN, van Vilsteren FGI, Weusten BLAM, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia. Jama. 2014;311(12):1209, 1217.

29.

Overholt BF, Lightdale CJ, Wang KK, Canto MI, Burdick S, Haggitt RC, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc. 2005;62(4):488–98.PubMed

30.

Krishnamoorthi R, Singh S, Ragunathan K, Katzka DA, Wang KK, Iyer PG. Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy. Gastrointest Endosc. 2016;83(6):1090–106.PubMedPubMedCentral

31.

• Wolf WA, Pasricha S, Cotton C, Li N, Triadafilopoulos G, Muthusamy VR, et al. Incidence of esophageal adenocarcinoma and causes of mortality after radiofrequency ablation of Barrett’s esophagus. Gastroenterology. 2015;149(7):1752–61 Results from this paper underscore that the incidence of EAC following RFA is low. Among patients undergoing RFA for BE, less than 1% died from EAC.PubMed

32.

Shaheen NJ, Overholt BF, Sampliner RE, Wolfsen HC, Wang KK, Fleischer DE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141(2):460–8.PubMed

33.

Solomon SS, Kothari S, Smallfield GB, et al. Liquid nitrogen spray cryotherapy is associated with less postprocedural pain than radiofrequency ablation in Barrett’s esophagus: a multicenter prospective study. J Clin Gastroenterol 2018 Jan 18 [Epub ahead of print].

34.

• Ramay F, Cui Q, Breenwald B. Outcomes after liquid nitrogen spray cryotherapy in Barrett’s esophagus-associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up. Gastrointest Endosc. 2017;86(4):626–32 This paper describes the known long-term durability of cryotherapy for the management of BE.PubMedPubMedCentral

35.

Cotton CC, Wolf WA, Pasricha S, Li N, Madanick RD, Spacek MB, et al. Recurrent intestinal metaplasia after radiofrequency ablation for Barrett’s esophagus: endoscopic findings and anatomic location. Gastrointest Endosc. 2015;81(6):1362–9.PubMedPubMedCentral

36.

Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76(6):1087–94.PubMed

37.

Cameron J, Carpenter H. Barrett’s esophagus, high-grade dysplasia, and early adenocarcinoma: a pathological study. Am J Gastroenterol. 1997;92(4):586–91.PubMed

38.

Pohl J, Pech O, May A, Manner H, Fissler-Eckhoff A, Ell C. Incidence of macroscopically occult neoplasias in Barrett’s esophagus: are random biopsies dispensable in the era of advanced endoscopic imaging? Am J Gastroenterol. 2010;105(11):2350–6.PubMed

39.

Abrams JA, Kapel RC, Lindberg GM, Saboorian MH, Genta RM, Neugut AI, et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol. 2009;7(7):736–42.PubMedPubMedCentral

40.

Thosani N, Abu Dayyeh BK, Sharma P, Aslanian HR, Enestvedt BK, Komanduri S, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance. Gastrointest Endosc. 2016;83(4):684–98 e7.

41.

Trindade AJ, Inamdar S, Sejpal DV, Rishi A, Sultan K. Targeting neoplasia using volumetric laser endomicroscopy with laser marking. Endoscopy. 2017;49:E54–5.PubMed

42.

Anandasabapathy S, Sontag S, Graham DY, Frist S, Bratton J, Harpaz N, et al. Computer-assisted brush-biopsy analysis for the detection of dysplasia in a high-risk Barrett’s esophagus surveillance population. Dig Dis Sci. 2011;56(3):761–6.PubMed

43.

Johanson JF, Frakes J, Eisen D. Computer-assisted analysis of abrasive transepithelial brush biopsies increases the effectiveness of esophageal screening: a multicenter prospective clinical trial by the endocdx collaborative group. Dig Dis Sci. 2011;56(3):767–72.PubMed

44.

• Jankowski JAZ, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial. Lancet. 2018;392(10145):400–8 Though not in a post-abliation cohort, this study provide clinical trial data describing the efficacy of aspirin and proton pump inhibitors for improving outcomes in Barrett's esophagus. The results suggest that high-dose proton pump inhibitors and aspirin may improve outcomes.

45.

Shafa S, Shaheen NJ. How I approach it: care of the post-ablation Barrett’s esophagus patient. Am J Gastroenterol. 2017;112(10):1487–90. https://doi.org/10.1038/ajg.2017.291.CrossRefPubMed

46.

Zhang S, Zhang X-Q, Ding X-W, Yang RK, Huang SL, Kastelein F, et al. Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett’s esophagus: a meta-analysis. Br J Cancer. 2014;110(9):2378–88.PubMedPubMedCentral

47.

Liao LM, Vaughan TL, Corley DA, Cook MB, Casson AG, Kamangar F, et al. Nonsteroidal anti-inflammatory drug use reduces risk of adenocarcinomas of the esophagus and esophagogastric junction in a pooled analysis. Gastroenterology. 2012;142(3):442–52.PubMed

48.

Small AJ, Sutherland SE, Hightower JS, et al. Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett’s esophagus. Gastrointest Endosc. 2015;81(5):1156–66.

49.

Pouw RE, Wirths K, Eisendrath P, et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol. 2010;8(1):23–9.PubMed

Titel: Durability of Endoscopic Treatment for Dysplastic Barrett’s Esophagus
verfasst von: Craig C. Reed, MD, MSCR
Nicholas J. Shaheen, MD, MPH
Publikationsdatum: 10.05.2019
Verlag: Springer US
Erschienen in: Current Treatment Options in Gastroenterology / Ausgabe 2/2019
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-019-00226-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

23.04.2024 | Ablationstherapie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Durability of Endoscopic Treatment for Dysplastic Barrett’s Esophagus

Abstract

Purpose of review

Recent findings

Summary

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose of review

Recent findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2019

Updates on Chronic HBV: Current Challenges and Future Goals

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults

Infections in Cirrhosis

Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Treatment of Bile Duct Stones

2007–2019: a “Third”-Space Odyssey in the Endoscopic Management of Gastrointestinal Tract Diseases

Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin