Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
Gastroenterology. 2013 Jul;145(1):96-104. doi: 10.1053/j.gastro.2013.03.046. Epub 2013 Mar 28.
BACKGROUND & AIMS: Radiofrequency ablation (RFA), with or without endoscopic resection effectively eradicates Barrett's esophagus (BE) containing high-grade intraepithelial neoplasia and/or early-stage cancer. We followed patients who received RFA for BE containing high-grade intraepithelial neoplasia and/or early-stage cancer for 5 years to determine the durability of treatment response. METHODS: We followed 54 patients with BE (2-12 cm), previously enrolled in 4 consecutive cohort studies in which they underwent focal endoscopic resection in case of visible lesions (n = 40 [72%]), followed by serial RFA every 3 months. Patients underwent high-resolution endoscopy with narrow-band imaging at 6 and 12 months after treatment and then annually for 5 years (median, 61 months; interquartile range, 53-65 months); random biopsy samples were collected from neosquamous epithelium and gastric cardia. After 5 years, endoscopic ultrasound and endoscopic resection of neosquamous epithelium were performed. Outcomes included sustained complete remission of neoplasia or intestinal metaplasia (IM), IM in gastric cardia, or buried glands in neosquamous epithelium. RESULTS: After 5 years, Kaplan-Meier analysis showed sustained complete remission of neoplasia and intestinal metaplasia in 90% of patients; neoplasia recurred in 3 patients and was managed endoscopically. Focal IM in the cardia was found in 19 of 54 patients (35%), in 53 of 1143 gastric cardia biopsies (4.6%). The incidence of IM of the cardia did not increase over time; and IM was diagnosed based on only a single biopsy in 89% of patients. Buried glands were detected in 3 of 3543 neosquamous epithelium biopsies (0.08%, from 3 patients). No endoscopic resection samples had buried glands. CONCLUSIONS: Among patients who have undergone RFA with or without endoscopic resection for neoplastic BE, 90% remain in remission at 5-year follow-up, with all recurrences managed endoscopically. This treatment approach is therefore an effective and durable alternative to esophagectomy; www.trialregister.nl number, NTR2938.
背景与目的：射频消融（RFA）联合或不联合内镜切除术可有效根除伴有高级别上皮内瘤变和/或早期癌症的 Barrett 食管（BE）。我们对接受 RFA 治疗伴有高级别上皮内瘤变和/或早期癌症的 BE 患者进行了 5 年随访，以确定治疗反应的持久性。
方法：我们对 54 例 BE（2-12 cm）患者进行了随访，这些患者先前在 4 项连续队列研究中入组，其中 40 例（72%）可见病变患者接受了局灶性内镜切除术，随后每 3 个月进行一次 RFA 治疗。治疗后 6 个月和 12 个月进行高分辨率内镜检查和窄带成像，随后每年进行一次，中位随访时间为 5 年（61 个月；四分位距，53-65 个月）；采集新生鳞状上皮和胃贲门的随机活检样本。5 年后，进行内镜超声和新生鳞状上皮内镜切除术。结局包括肿瘤或肠化生（IM）、胃贲门 IM 或新生鳞状上皮中埋藏腺体的持续完全缓解。
结果：5 年后，Kaplan-Meier 分析显示 90%的患者肿瘤和肠化生持续完全缓解；3 例患者出现肿瘤复发，均经内镜治疗。54 例患者中有 19 例（35%）出现贲门局灶性 IM，1143 次胃贲门活检中有 53 次（4.6%）出现 IM。IM 的发生率随时间推移无增加；89%的患者仅基于单次活检即可诊断 IM。3543 次新生鳞状上皮活检中发现 3 例（0.08%，来自 3 例患者）存在埋藏腺体。无内镜切除标本发现埋藏腺体。
结论：在接受 RFA 联合或不联合内镜切除术治疗的肿瘤性 BE 患者中，90%在 5 年随访时仍处于缓解状态，所有复发均经内镜治疗。因此，与食管切除术相比，这种治疗方法是一种有效且持久的替代方法；www.trialregister.nl 编号，NTR2938。
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