Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France.
Surg Endosc. 2017 Sep;31(9):3703-3710. doi: 10.1007/s00464-016-5409-5. Epub 2017 Jan 11.
Endotherapy in cases of neoplastic Barrett esophagus (BE) relapse after successful initial endoscopic management is commonly accepted, but few studies analyze this topic and also take into account the metachronous lesions.
To evaluate the efficiency of endotherapy in the case of neoplastic BE relapse after successful complete endoscopic eradication of neoplastic BE and metaplastic BE.
Retrospective review of medical records was collected in a computerized and prospective manner between 2000 and 2015, in a single tertiary care center. Recurrence was defined by histological presence of high-grade dysplasia or superficial adenocarcinoma at least 6 months after the end of successful initial endotherapy.
Eighteen patients were assessed (1F/17 M). Delay between initial treatment and relapse was 16.6 months (range 6-33). Endotherapy for relapse obtained a sustained and complete remission for 8/18 (44%) patients, with an average endoscopic follow-up of 28 months. The complication rate of endotherapy was 6%. Surgical management was required in 33% (2 pT2N0M0, 2 pTisN0M0, 1 pTm2N0M0 and 1 pTm3N0M0) and salvage radiochemotherapy in 17% (3/18). One patient treated by 6 sessions of ER was considered as a failure given the multiple sessions of endotherapy. Multivariate analysis showed that length of BE (>5 cm), late stenosis adverse events and the quality of vertical margin during initial ER are predictive factors for disease-free survival (p value < 0.01, Hazard Ratio up to 0.076).
Endotherapy could be a treatment for management of neoplastic BE relapse, but should be carefully used, with strict follow-up.
在成功初始内镜治疗后，针对肿瘤性 Barrett 食管（BE）复发的腔内治疗是被广泛接受的，但很少有研究对这一主题进行分析，也没有考虑到同时性病变。
评估成功的肿瘤性 BE 和化生性 BE 完全内镜消除后，针对肿瘤性 BE 复发时腔内治疗的效率。
在 2000 年至 2015 年间，在一个单一的三级护理中心，通过计算机和前瞻性方式收集了病历的回顾性审查。复发的定义为初始成功内镜治疗结束至少 6 个月后组织学存在高级别异型增生或表浅腺癌。
共评估了 18 例患者（1 例女性，17 例男性）。初始治疗与复发之间的延迟为 16.6 个月（范围 6-33）。针对复发的腔内治疗使 8/18（44%）患者获得持续和完全缓解，平均内镜随访 28 个月。腔内治疗的并发症发生率为 6%。33%（2 例 pT2N0M0、2 例 pTisN0M0、1 例 pTm2N0M0 和 1 例 pTm3N0M0）需要手术治疗，17%（18 例中有 3 例）需要挽救性放化疗。1 例接受 6 次 ER 治疗的患者因多次腔内治疗被认为是失败病例。多变量分析显示，BE 长度（>5cm）、晚期狭窄不良事件以及初始 ER 中垂直边缘的质量是无疾病生存的预测因素（p 值<0.01，风险比高达 0.076）。
腔内治疗可能是治疗肿瘤性 BE 复发的一种方法，但应谨慎使用，并进行严格随访。
