Journal ArticleDOI
Endoscopic radiofrequency ablation or surveillance in patients with Barrett's oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial.
Maximilien Barret,Mathieu Pioche,Benoit Terris,Thierry Ponchon,Franck Cholet,Frank Zerbib,Edouard Chabrun,Marc Le Rhun,Emmanuel Coron,Marc Giovannini,Fabrice Caillol,René Laugier,Jérémie Jacques,Romain Legros,Christian Boustière,Gabriel Rahmi,E Metivier-Cesbron,Geoffroy Vanbiervliet,P. Bauret,Jean Escourrou,Julien Branche,Lea Jilet,Hendy Abdoul,Nadira Kaddour,Sarah Leblanc,Michael Bensoussan,Frédéric Prat,Stanislas Chaussade +27 more
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In this article, the authors compared radiofrequency ablation (RFA) and surveillance for Barrett's oesophagus (BO) with low grade dysplasia (LGD).Abstract:
Objective Due to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design. Design A prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity. Results 125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p Conclusion RFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD. Trial registration number NCT01360541.read more
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Journal ArticleDOI
Barrett Esophagus: A Review.
TL;DR: Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years to monitor for progression to esophageal adenocarcinoma.
Journal ArticleDOI
Endoscopic Management of Barrett's Esophagus
TL;DR: Barrett’s esophagus is considered to be one of the most important identifiable risk factors leading to development of EAC, and the mortality associated with EAC is high, with a 5-year survival rate of only 15% (Pondugula et al. 2007; Wani and Sharma 2007a).
Journal ArticleDOI
Development and external validation of a model to predict complex treatment after RFA for Barrett's esophagus with early neoplasia.
Sanne N. van Munster,Esther Nieuwenhuis,Raf Bisschops,Hilde Willekens,Bas L. Weusten,Lorenza Alvarez Herrero,Auke Bogte,Alaa Alkhalaf,B.E. Schenk,Erik J. Schoon,Wouter L. Curvers,Arjun D. Koch,Pieter J F de Jonge,T Tang,Wouter B. Nagengast,Jessie Westerhof,M. H. M. G. Houben,Jacques J. Bergman,Roos E. Pouw +18 more
TL;DR: In this paper , the authors developed a prognostic model using logistic regression to identify patients with high grade dysplasia/esophageal adenocarcinoma and those with poor squamous regeneration.
Journal ArticleDOI
Predictive factors of radiofrequency ablation failure in the treatment of dysplastic Barrett's esophagus.
Simon Weiss,Anna Pellat,Félix Corre,Einas Abou Ali,Arthur Belle,Benoit Terris,Mahaut Leconte,Anthony Dohan,Stanislas Chaussade,Romain Coriat,Maximilien Barret +10 more
TL;DR: In this paper , the authors conducted a single-center retrospective study from a prospectively collected database from 2011 to 2020, including all consecutive patients treated with RFA for flat dysplastic Barrett's esophagus.
Journal ArticleDOI
Endoscopic Diagnosis and Management of Barrett’s Esophagus with Low-Grade Dysplasia
Francesco Milone,Alessia Chini,Rosa Maione,Michele Manigrasso,A Marello,Gianluca Cassese,Nicola Gennarelli,Marco Milone,Giovanni Domenico De Palma +8 more
TL;DR: Although endoscopic surveillance is preferred, several minimally invasive endoscopic therapeutic approaches are available; novel endoscopic treatments are cryotherapy ablation and argon plasma coagulation, that have good rates of eradication with less complications and post-procedural pain.
References
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Natural History of Cervical Intraepithelial Neoplasia: A Critical Review
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Journal ArticleDOI
Radiofrequency Ablation in Barrett's Esophagus with Dysplasia
Nicholas J. Shaheen,Prateek Sharma,Bergein F. Overholt,Herbert C. Wolfsen,Richard E. Sampliner,Kenneth K. Wang,Joseph A. Galanko,Mary P. Bronner,John R. Goldblum,Ana E. Bennett,Blair A. Jobe,Glenn M. Eisen,M. Brian Fennerty,John G. Hunter,David E. Fleischer,Virender K. Sharma,Robert H. Hawes,Brenda J. Hoffman,Richard I. Rothstein,Stuart R. Gordon,Hiroshi Mashimo,Kenneth J. Chang,V. Raman Muthusamy,Steven A. Edmundowicz,Stuart J. Spechler,Ali A. Siddiqui,Rhonda F. Souza,Anthony Infantolino,Gary W. Falk,Michael B. Kimmey,Ryan D. Madanick,Amitabh Chak,Charles J. Lightdale +32 more
TL;DR: In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia, and a reduced risk of disease progression.
Journal ArticleDOI
ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus
TL;DR: Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma, and endoscopic surveillance intervals are attenuated, based on recent level 1 evidence.
Journal ArticleDOI
Incidence of Adenocarcinoma among Patients with Barrett's Esophagus
Frederik Hvid-Jensen,Lars Pedersen,Asbjørn Mohr Drewes,Henrik Toft Sørensen,Peter Funch-Jensen +4 more
TL;DR: Barrett's esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of 0.5%, which is the basis for current surveillance guidelines.