Endoscopic Therapy for Barrett's Esophagus
Endoscopic Therapy for Barrett's Esophagus
Recent retrospective cohort data and a prospective randomized sham controlled trial have clearly documented the impact of endoscopic ablation therapy on dysplasia and Barrett's esophagus (BE). The clinical indications for ablation of BE includes high-grade dysplasia and intramucosal adenocarcinoma. The techniques of resection of mucosal irregularities and of ablation are reviewed, primarily thermal and photodynamic ablation. Ablation of BE with neoplasia has appropriately entered the clinical arena.
Endoscopic therapy for Barrett's esophagus (BE) has been used for 20 years. It has been applied increasingly around the world although it has been met with skepticism by some. A recent retrospective cohort series of surgery versus endoscopic therapy and a prospective randomized sham controlled trial of endoscopic therapy have catapulted this intervention into the clinical arena. This article reviews the indications for BE ablation; the techniques for ablation; their advantages, disadvantages, and level of documentation; and the goals of endoscopic therapy.
Retrospective cohorts from one high-volume institution have reported equivalent results from surgery and endoscopic therapy for BE with high-grade dysplasia (HGD). Seventy patients underwent esophagectomy and 129 patients underwent photodynamic therapy (PDT). The majority of the PDT patients also underwent endoscopic resection (ER) of mucosal lesions. The overall mortality in each group was similar (9%) over a 5-year follow-up period. There were no deaths from esophageal adenocarcinoma in either cohort.
In addition, a prospective randomized sham controlled trial of radiofrequency ablation (RFA) was conducted in 22 centers and has been reported in abstract form. The 1-year interim analysis of 101 patients with HGD and low-grade dysplasia (LGD) showed a reduction of neoplasia progression (LGD to HGD or HGD to cancer) from 19% to 5%. In addition, 77% of treated patients had clearance of intestinal metaplasia (IM) (ie, BE) versus none in the sham arm. These 2 major studies represent the beginning of the documentation of the efficacy of Barrett's ablation.
Abstract and Introduction
Abstract
Recent retrospective cohort data and a prospective randomized sham controlled trial have clearly documented the impact of endoscopic ablation therapy on dysplasia and Barrett's esophagus (BE). The clinical indications for ablation of BE includes high-grade dysplasia and intramucosal adenocarcinoma. The techniques of resection of mucosal irregularities and of ablation are reviewed, primarily thermal and photodynamic ablation. Ablation of BE with neoplasia has appropriately entered the clinical arena.
Introduction
Endoscopic therapy for Barrett's esophagus (BE) has been used for 20 years. It has been applied increasingly around the world although it has been met with skepticism by some. A recent retrospective cohort series of surgery versus endoscopic therapy and a prospective randomized sham controlled trial of endoscopic therapy have catapulted this intervention into the clinical arena. This article reviews the indications for BE ablation; the techniques for ablation; their advantages, disadvantages, and level of documentation; and the goals of endoscopic therapy.
Retrospective cohorts from one high-volume institution have reported equivalent results from surgery and endoscopic therapy for BE with high-grade dysplasia (HGD). Seventy patients underwent esophagectomy and 129 patients underwent photodynamic therapy (PDT). The majority of the PDT patients also underwent endoscopic resection (ER) of mucosal lesions. The overall mortality in each group was similar (9%) over a 5-year follow-up period. There were no deaths from esophageal adenocarcinoma in either cohort.
In addition, a prospective randomized sham controlled trial of radiofrequency ablation (RFA) was conducted in 22 centers and has been reported in abstract form. The 1-year interim analysis of 101 patients with HGD and low-grade dysplasia (LGD) showed a reduction of neoplasia progression (LGD to HGD or HGD to cancer) from 19% to 5%. In addition, 77% of treated patients had clearance of intestinal metaplasia (IM) (ie, BE) versus none in the sham arm. These 2 major studies represent the beginning of the documentation of the efficacy of Barrett's ablation.
Source...