Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Gastrointest Endosc. 2013 Apr;77(4):534-41. doi: 10.1016/j.gie.2012.10.021. Epub 2013 Jan 3.
The safety, efficacy, and durability of radiofrequency ablation (RFA), with or without EMR, have been established for long-segment Barrett's esophagus (LSBE). Ablating ultralong-segment Barrett's esophagus (ULSBE) may be associated with increased stricture formation, eradication failure, and treatment session requirements.
Our primary objective was to compare eradication and stricture rates between LSBE (≥3 to <8 cm) and ULSBE (≥8 cm). Our secondary objective was to evaluate treatment durability and session requirements.
Retrospective review of prospectively collected data.
Tertiary care facility.
A total of 72 patients (34 ULSBE, 38 LSBE; mean Barrett's segment length of 10.8 and 4.7 cm) underwent RFA between August 2005 and September 2010. Mean follow-up was 45 and 34 months, respectively.
Eradication and complication rates for ULSBE and LSBE.
Eradication rates for dysplasia (90% vs 88%, P = 1.0) and intestinal metaplasia (IM) (77% vs 82%, P = .77) were similar. ULSBE patients required more overall (P < .01) and circumferential (P < .01) RFA; however, stricture rates were identical (14%). There was no dysplasia recurrence, and IM recurrence was similar (ULSBE, 23%; LSBE, 16%; P = .52). At 3 years, IM remained eradicated in 65% of ULSBE and 82% of LSBE, without maintenance RFA. On multivariate regression analysis, increasing Barrett's length was associated with a reduced likelihood for eradicating IM (odds ratio 0.87; 95% CI, 0.75-1.00), but not dysplasia (odds ratio 1.13; 95% CI, 0.95-1.35).
Single center.
ULSBE can be treated in its entirety at each session with efficacy and safety comparable to LSBE. ULSBE requires more effort to achieve IM eradication, and RFA is less durable in maintaining this eradication at 3-year follow-up.
射频消融（RFA）联合或不联合内镜黏膜切除术（EMR）治疗长节段 Barrett 食管（LSBE）的安全性、有效性和持久性已得到证实。消融超长节段 Barrett 食管（ULSBE）可能与更高的狭窄形成、根除失败和治疗疗程要求相关。
我们的主要目的是比较 LSBE（≥3 至<8cm）和 ULSBE（≥8cm）之间的根除率和狭窄率。我们的次要目标是评估治疗的持久性和疗程要求。
前瞻性收集数据的回顾性研究。
三级保健机构。
2005 年 8 月至 2010 年 9 月间共有 72 例患者（34 例 ULSBE，38 例 LSBE；Barrett 食管段平均长度分别为 10.8cm 和 4.7cm）接受了 RFA 治疗。平均随访时间分别为 45 个月和 34 个月。
ULSBE 和 LSBE 的根除率和并发症发生率。
对异型增生（90%与 88%，P=1.0）和肠化生（IM）（77%与 82%，P=0.77）的根除率相似。ULSBE 患者需要更多的总体（P<0.01）和环形（P<0.01）RFA；然而，狭窄率相同（14%）。无异型增生复发，IM 复发相似（ULSBE，23%；LSBE，16%；P=0.52）。3 年后，65%的 ULSBE 和 82%的 LSBE 仍未根除 IM，且未进行维持性 RFA。多变量回归分析显示，Barrett 食管长度的增加与 IM 根除的可能性降低相关（比值比 0.87；95%可信区间，0.75-1.00），但与异型增生无关（比值比 1.13；95%可信区间，0.95-1.35）。
单中心。
ULSBE 可在每次治疗时整块消融，疗效和安全性与 LSBE 相当。与 LSBE 相比，ULSBE 更难达到 IM 的根除，在 3 年随访时，RFA 维持这种根除的持久性较差。
