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01.12.2014 | Ausgabe 12/2014

Surgical Endoscopy 12/2014

Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study

Zeitschrift:
Surgical Endoscopy > Ausgabe 12/2014
Autoren:
Adam C. Strauss, Agoston T. Agoston, Parambir S. Dulai, Amitabh Srivastava, Richard I. Rothstein
Wichtige Hinweise
Presented at the SAGES 2014 Annual Meeting, April 2–5, 2014, Salt Lake City, Utah.

Abstract

Background

Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), has been validated as a safe, effective and durable treatment option for dysplastic Barrett’s esophagus. Its durability in eradicating Barrett’s-associated intramucosal carcinoma (IMC), however, is unclear. We set out to assess the long-term safety and efficacy of RFA for IMC.

Methods

Retrospective review of two tertiary care facility records for patients undergoing RFA, with or without EMR, for biopsy-proven IMC. Our primary outcome of interest was to quantify the rate of durable complete eradication for intestinal metaplasia and for IMC and associated dysplasia. A multi-variate regression analysis was performed to identify features which correlate with durable eradication of IMC/dysplasia. Our secondary outcome of interest was treatment-related complications.

Results

36 patients (26 male; mean age 64 ± 12 years), with a mean Barrett’s length of 3.5 ± 2.5 cm, underwent RFA for biopsy-proven IMC. EMR was performed in 31 (86 %) prior to or during RFA. Complete eradication of IMC/dysplasia was achieved in 32/36 (89 %) and patients required a mean of 1 ± 1 EMR and 2 ± 1 RFA sessions to achieve eradication. During a mean follow-up period of 24 ± 19 months, durable complete eradication of IMC/dysplasia was achieved in 29/36 (81 %) patients. On multi-variate regression analysis, undergoing an EMR prior to RFA was associated with an increased likelihood of maintaining durable eradication of IMC/dysplasia (p = 0.03). Treatment-related complications included: bleeding (3 %) and stricture formation (19 %).

Conclusion

RFA is an effective and durable treatment option for Barrett’s-associated IMC. Greater than 80 % of patients will achieve and maintain complete eradication of IMC at a mean of 2 years follow-up.

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