David Waseem J, Qumseya Bashar J, Qumsiyeh Yazen, Heckman Michael G, Diehl Nancy N, Wallace Michael B, Raimondo Massimo, Woodward Timothy A, Wolfsen Herbert C
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; Florida State University, Archbold Medical Group, Thomasville, Georgia, USA.
Gastrointest Endosc. 2015 Nov;82(5):793-803.e3. doi: 10.1016/j.gie.2015.03.1979. Epub 2015 Jun 10.
There are few data comparing endoscopic treatment outcomes for Barrett's esophagus (BE).
To compare treatment outcomes in BE patients treated with radiofrequency ablation (RFA), RFA after EMR, and porfimer sodium photodynamic therapy (Ps-PDT).
Retrospective, observational study.
Single tertiary center between 2001 and 2013.
A total of 342 BE patients treated with RFA (n = 119), EMR+RFA (n = 98), and Ps-PDT (n = 125).
Rates of complete remission of intestinal metaplasia (CRIM), BE recurrence, and adverse events.
Baseline BE high-grade dysplasia (HGD) and adenocarcinoma were more common in the Ps-PDT group (89%) compared with the EMR-RFA (70%) and RFA (37%) groups. At a median follow-up of 14.2 months, 173 patients (50.6%) achieved CRIM. CRIM was significantly more common in Ps-PDT patients compared with RFA (P < .001) and EMR-RFA (P < .001) patients on multivariable analysis. In patients who achieved CRIM, the rates of subsequent BE recurrence were relatively similar among the 3 groups. Although the rates of bleeding were similar, strictures were less common in RFA patients (2.4%) compared with EMR-RFA (13.3%, P = .001) and Ps-PDT (10.4%, P =.043) patients.
This study of endoscopic treatment for Barrett's dysplasia and neoplasia found that complete remission was achieved more often and more rapidly after Ps-PDT with similar disease recurrence rates compared with EMR or RFA. Adverse events were more common after EMR and Ps-PDT. Further studies are required to determine which ablation and resection techniques are ideally suited for each BE patient.
比较巴雷特食管（BE）内镜治疗效果的数据较少。
比较接受射频消融（RFA）、内镜黏膜切除术（EMR）后行RFA以及卟吩姆钠光动力疗法（Ps-PDT）治疗的BE患者的治疗效果。
回顾性观察研究。
2001年至2013年期间的一家三级中心。
共有342例BE患者接受了RFA（n = 119）、EMR+RFA（n = 98）和Ps-PDT（n = 125）治疗。
肠化生完全缓解率（CRIM）、BE复发率和不良事件。
与EMR-RFA组（70%）和RFA组（37%）相比，Ps-PDT组基线BE高级别异型增生（HGD）和腺癌更为常见（89%）。中位随访14.2个月时，173例患者（50.6%）实现了CRIM。多变量分析显示，与RFA患者（P <.001）和EMR-RFA患者（P <.001）相比，Ps-PDT患者的CRIM明显更为常见。在实现CRIM的患者中，三组后续BE复发率相对相似。虽然出血率相似，但与EMR-RFA患者（13.3%，P =.001）和Ps-PDT患者（10.4%，P =.043）相比，RFA患者的狭窄较少见（2.4%）。
这项关于巴雷特异型增生和肿瘤内镜治疗的研究发现，与EMR或RFA相比，Ps-PDT后更常且更快实现完全缓解，疾病复发率相似。EMR和Ps-PDT后不良事件更常见。需要进一步研究以确定哪种消融和切除技术最适合每位BE患者。
