Tan Wei Keith, Ragunath Krish, White Jonathan R, Santiago Jose, Fernandez-Sordo Jacobo Ortiz, Pana Mirela, Alias Bincy, Hadjinicolaou Andreas V, Sujendran Vijay, di Pietro Massimiliano
MRC Cancer unit, University of Cambridge, Cambridge, UK.
Department of Gastroenterology, Addenbrookes Hospital, Cambridge, UK.
Endosc Int Open. 2020 Feb;8(2):E189-E195. doi: 10.1055/a-1005-6331. Epub 2020 Jan 22.
The standard radiofrequency ablation (RFA) protocol for Barrett's esophagus (BE) encompasses an intermediary cleaning phase between two ablation sessions. A simplified protocol omitting the cleaning phase is less labor-intensive but equally effective in studies based on single ablation procedures. The aim of this study was to compare efficacy and safety of the standard and simplified RFA protocols for the whole treatment pathway for BE, including both circumferential and focal devices. We performed a retrospective analysis of prospectively collected data on patients receiving RFA between January 2007 and August 2017 at two institutions. Outcomes assessed were: 1) complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM) at 18 months; and 2) rate of esophageal strictures. One hundred forty-five patients were included of whom 73 patients received the standard and 72 patients received the simplified protocol. CR-D was achieved in 94.5 % and 95.8 % of patients receiving the standard and simplified protocol, respectively ( = 0.71). CR-IM was achieved in 84.9 % and 77.8 % of patients treated with the standard and simplified protocol, respectively ( = 0.27). Strictures were significantly more common among patients who received the simplified protocol (12.5 %) compared to the standard protocol (1.4 %; = 0.008). The median number of esophageal dilations was one. The simplified RFA protocol is as effective as the standard protocol in eradicating BE but carries a higher risk of strictures. This needs to be taken into account, particularly in patients with higher pretreatment risk of strictures, such as those with esophageal narrowing from previous endoscopic mucosal resection (EMR).
巴雷特食管（BE）的标准射频消融（RFA）方案在两次消融疗程之间包含一个中间清洁阶段。在基于单次消融手术的研究中，省略清洁阶段的简化方案劳动强度较低，但效果相同。本研究的目的是比较标准和简化RFA方案在BE整个治疗过程中的疗效和安全性，包括环形和聚焦装置。我们对2007年1月至2017年8月期间在两家机构接受RFA治疗的患者的前瞻性收集数据进行了回顾性分析。评估的结果包括：1）18个月时发育异常完全缓解（CR-D）和肠化生完全缓解（CR-IM）；2）食管狭窄发生率。纳入了145例患者，其中73例接受标准方案，72例接受简化方案。接受标准方案和简化方案的患者中，分别有94.5%和95.8%实现了CR-D（P = 0.71）。接受标准方案和简化方案治疗的患者中，分别有84.9%和77.8%实现了CR-IM（P = 0.27）。与标准方案（1.4%）相比，接受简化方案的患者中狭窄明显更常见（12.5%；P = 0.008）。食管扩张的中位数为1次。简化RFA方案在根除BE方面与标准方案一样有效，但发生狭窄的风险更高。这一点需要考虑，特别是在术前狭窄风险较高的患者中，如那些因先前内镜黏膜切除术（EMR）导致食管狭窄的患者。
