Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Endoscopy. 2013 Jul;45(7):516-25. doi: 10.1055/s-0032-1326423. Epub 2013 Apr 11.
Radiofrequency ablation (RFA) is safe and effective for the eradication of neoplastic Barrett's esophagus; however, occasionally there is minimal regression after initial circumferential balloon-based RFA (c-RFA). This study aimed to identify predictive factors for a poor response 3 months after c-RFA, and to relate the percentage regression at 3 months to the final treatment outcome.
We included consecutive patients from 14 centers who underwent c-RFA for high grade dysplasia at worst. Patient and treatment characteristics were registered prospectively. "Poor initial response" was defined as < 50 % regression of the Barrett's esophagus 3 months after c-RFA, graded by two expert endoscopists using endoscopic images. Predictors of initial response were identified through logistic regression analysis.
There were 278 patients included (median Barrett's segment C4M6). In poor initial responders (n = 36; 13 %), complete response for neoplasia (CR-neoplasia) was ultimately achieved in 86 % (vs. 98 % in good responders; P < 0.01) and complete response for intestinal metaplasia (CR-IM) in 66 % (vs. 95 %; P < 0.01). Poor responders required 13 months treatment (vs. 7 months; P < 0.01) for a median of four RFA sessions (vs. three; P < 0.01). We identified four independent baseline predictors of poor response: active reflux esophagitis (odds ratio [OR] 37.4; 95 % confidence interval [CI] 3.2 - 433.2); endoscopic resection scar regeneration with Barrett's epithelium (OR 4.7; 95 %CI 1.1 - 20.0); esophageal narrowing pre-RFA (OR 3.9; 95 %CI 1.0 - 15.1); and years of neoplasia pre-RFA (OR 1.2; 95 %CI 1.0 - 1.4).
Patients with a poor initial response to c-RFA have a lower ultimate success rate for CR-neoplasia/CR-IM, require more treatment sessions, and a longer treatment period. A poor initial response to c-RFA occurs more frequently in patients who regenerate their endoscopic resection scar with Barrett's epithelium, and those with ongoing reflux esophagitis, neoplasia in Barrett's esophagus for a longer time, or a narrow esophagus.
射频消融（RFA）是安全有效的方法，可用于消除肿瘤性 Barrett 食管；然而，在初始环形气球基 RFA（c-RFA）后，偶尔会出现最小程度的消退。本研究旨在确定 c-RFA 后 3 个月时反应不佳的预测因素，并将 3 个月时的消退百分比与最终治疗结果相关联。
我们纳入了来自 14 个中心的连续患者，这些患者的最差病变为高级别异型增生。前瞻性地记录了患者和治疗特征。通过两位专家内镜医生使用内镜图像，将“初始反应不佳”定义为 c-RFA 后 3 个月时 Barrett 食管的消退＜50％。通过逻辑回归分析确定初始反应的预测因素。
共纳入 278 例患者（中位 Barrett 段 C4M6）。在初始反应不佳的患者（n=36；13％）中，最终有 86％（与良好反应者的 98％相比；P＜0.01）和 66％（与良好反应者的 95％相比；P＜0.01）达到了肿瘤的完全缓解（CR-neoplasia）和肠化生的完全缓解（CR-IM）。反应不佳的患者需要 13 个月的治疗（与 7 个月相比；P＜0.01），中位数为 4 次 RFA 治疗（与 3 次相比；P＜0.01）。我们确定了 4 个独立的基线反应不佳预测因素：活动性反流性食管炎（优势比[OR]37.4；95％置信区间[CI]3.2-433.2）；内镜切除瘢痕再生伴有 Barrett 上皮（OR 4.7；95％CI 1.1-20.0）；RFA 前食管狭窄（OR 3.9；95％CI 1.0-15.1）；和 RFA 前的异型增生时间（OR 1.2；95％CI 1.0-1.4）。
对 c-RFA 初始反应不佳的患者，其最终获得肿瘤完全缓解/肠化生完全缓解的成功率较低，需要更多的治疗次数和更长的治疗时间。在那些内镜切除瘢痕再生伴有 Barrett 上皮的患者、那些持续存在反流性食管炎的患者、那些在 Barrett 食管中有更长时间异型增生的患者、或者那些食管狭窄的患者中，c-RFA 初始反应不佳的情况更为常见。
