Haidry R J, Butt M A, Dunn J M, Gupta A, Lipman G, Smart H L, Bhandari P, Smith L, Willert R, Fullarton G, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Kapoor N, Hoare J, Narayanasamy R, Ang Y, Veitch A, Ragunath K, Novelli M, Lovat L B
Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK.
Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK.
Gut. 2015 Aug;64(8):1192-9. doi: 10.1136/gutjnl-2014-308501. Epub 2014 Dec 24.
Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.
We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated.
508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).
Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients.
ISRCTN93069556.
巴雷特食管（BE）是一种癌前病变，可导致食管腺癌（OAC）。早期肿瘤的治疗是可取的。对于患有BE相关肿瘤的患者，联合内镜黏膜切除术（EMR）后进行射频消融（RFA）是手术的一种替代方法。
我们研究了2008年至2013年英国接受RFA/EMR治疗BE相关肿瘤患者的登记前瞻性数据。在RFA之前，通过EMR切除可见病变。此后，患者每3个月进行一次RFA，直到所有BE被消融或发生癌症（终点）。建议在首次RFA治疗后约12个月或达到终点时进行治疗结束活检。在两个时间段（2008 - 2010年和2011 - 2013年）评估治疗结束时发育异常清除（CR - D）和BE清除（CR - IM）的结果。还评估了成功治疗的持久性和进展为OAC的情况。
508例患者已完成治疗。CR - D和CR - IM在前后时间段之间有显著改善，分别从77%和56%提高到92%和83%（p<0.0001）。RFA前对可见病变进行EMR的比例从48%增加到60%（p = 0.013）。RFA后挽救性EMR从13%下降到2%（p<0.0001）。12个月时进展为OAC的情况无显著差异（3.6%对2.1%，p = 0.51）。
在过去6年中，BE肿瘤的临床结果有显著改善，病变识别能力提高，且在RFA前对可见病变进行积极切除。尽管技术有所进步，但在这些高危患者中，1年时癌症进展率仍为2% - 4%。
ISRCTN93069556。
