Pouw Roos E, Gondrie Joep J, Sondermeijer Carine M, ten Kate Fiebo J, van Gulik Thomas M, Krishnadath Kausilia K, Fockens Paul, Weusten Bas L, Bergman Jacques J
Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J Gastrointest Surg. 2008 Oct;12(10):1627-36; discussion 1636-7. doi: 10.1007/s11605-008-0629-1. Epub 2008 Aug 13.
Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008.
Enrolled patients had BE < or = 12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloon-based catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated.
Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n = 16), high-grade dysplasia (n = 12), low-grade dysplasia (n = 3)]. Worst histology remaining after resection was high-grade (n = 32), low-grade (n = 10), or no (n = 2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n = 3) and transient dysphagia (n = 4). After 21 months of follow-up (interquartile range 10-27), no dysplasia had recurred.
Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.
射频消融术对于完全根除非发育异常的巴雷特食管（BE）安全有效。目的是报告在2008年消化疾病周（DDW）SSAT主席全会上发表的两项关于伴有早期肿瘤的BE射频消融术的研究结果以及两项正在进行的研究结果。
纳入的患者BE长度≤12 cm且伴有早期肿瘤。可见病变经内镜切除。使用基于球囊的导管进行环形消融，使用基于内镜的导管进行局部消融。每2个月重复消融一次，直到整个巴雷特上皮在内镜和组织学上被根除。
纳入44例患者（35例男性，中位年龄68岁，中位BE长度7 cm）。31例患者首先接受了内镜切除[早期癌症（n = 16）、高级别异型增生（n = 12）、低级别异型增生（n = 3）]。切除后残留的最差组织学类型为高级别（n = 32）、低级别（n = 10）或无（n = 2）异型增生。消融后，43例患者（98%）实现了所有异型增生和肠化生的完全组织学根除。消融后的并发症包括切除部位的黏膜撕裂（n = 3）和短暂性吞咽困难（n = 4）。经过21个月的随访（四分位间距为10 - 27个月），无异型增生复发。
无论是否对可见异常先行内镜切除，射频消融术在根除BE及相关肿瘤方面均有效且安全。
