Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Dig Dis Sci. 2011 Jul;56(7):1996-2000. doi: 10.1007/s10620-011-1680-4. Epub 2011 Apr 6.
Radiofrequency ablation (RFA) is an effective means of eradicating Barrett's esophagus (BE), both with and without associated dysplasia. Several studies have documented high initial success rates with RFA. However, there is limited data on IM detection rates after eradication.
To determine the rate of detection of intestinal metaplasia (IM) after successful eradication of Barrett's esophagus.
BE patients with and without dysplasia who had undergone RFA were retrospectively identified. Only those who had complete eradication as documented on the initial post-ablation endoscopy, and had minimum two surveillance endoscopies, were included in the analyses. Clinical, demographic, and endoscopic data were collected. Cumulative incidence of IM detection was calculated by the Kaplan-Meier method.
Forty-seven patients underwent RFA and had complete eradication of Barrett's epithelium. The majority of patients were male (76.6%), and the mean age was 64.2 years. The cumulative incidence of newly detected IM at 1 year was 25.9% (95% CI 15.1-42.1%). Dysplasia was detected at the time of recurrence in four patients, and all cases were detected at the GE junction in the absence of visible BE. Patients with recurrent IM had longer baseline segments of BE (median, 4 cm vs. 2 cm, p = 0.03).
The rate of detection of new IM is high in patients who have undergone successful eradication of BE by RFA. Additionally, dysplasia can recur at the GE junction in the absence of visible BE. Future studies are warranted to identify those patients at increased risk for the development of recurrent intestinal metaplasia.
射频消融 (RFA) 是一种有效根除 Barrett 食管 (BE) 的方法,无论是伴有还是不伴有异型增生。多项研究已经证明 RFA 的初始成功率很高。然而,关于 BE 根除后 IM 检测率的数据有限。
确定成功根除 Barrett 食管后肠上皮化生 (IM) 的检出率。
回顾性确定接受 RFA 治疗的伴有和不伴有异型增生的 BE 患者。仅纳入那些在初始消融后内镜检查中确认为完全根除且至少进行了两次内镜监测的患者。收集临床、人口统计学和内镜数据。采用 Kaplan-Meier 方法计算 IM 检出的累积发生率。
47 例患者接受了 RFA 治疗,并完全根除了 Barrett 上皮。大多数患者为男性 (76.6%),平均年龄为 64.2 岁。1 年后新检出 IM 的累积发生率为 25.9% (95%CI 15.1-42.1%)。4 例患者在复发时检出异型增生,所有病例均在无可见 BE 的胃食管交界处检出。复发 IM 的患者基线 BE 段较长 (中位数 4cm 与 2cm,p=0.03)。
RFA 成功根除 BE 后,新检出 IM 的发生率较高。此外,异型增生可在无可见 BE 的情况下在胃食管交界处复发。需要进一步研究以确定那些发生复发性肠上皮化生风险增加的患者。