Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2021 Apr;93(4):880-887.e1. doi: 10.1016/j.gie.2020.07.056. Epub 2020 Jul 31.
Radiofrequency ablation (RFA) is the preferred ablative modality for treating dysplastic Barrett's esophagus. The recently introduced self-sizing circumferential ablation catheter eliminates the need for a sizing balloon. Although it enhances efficiency, outcomes have not been compared with the previous manual-sizing catheter. We evaluated the comparative safety and efficacy of these 2 ablation systems in a large, multicenter cohort.
Patients undergoing RFA at 3 tertiary care centers from 2005 to 2018 were included. Circumferential RFA was performed in a standard fashion, followed by focal RFA as needed. Outcomes were compared between the self-sizing and manual-sizing groups. The primary outcome was the rate of adverse events, including strictures, perforation, and bleeding. Secondary outcomes were procedure time and treatment efficacy, as assessed by rates and time to complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM).
Three hundred eighteen patients were included, 90 (28.3%) treated with the self-sizing catheter and 228 (71.7%) with the manual-sizing catheter. Twenty-one patients (6.6%) developed strictures (8 [8.9%] in the self-sizing group and 13 [5.7%] in the manual-sizing group, P = .32). Of the self-sizing strictures, 75% occurred at the 12J dose before widespread adoption of the current 10J treatment standard. One patient developed bleeding, and no perforations were encountered. Procedure time was significantly shorter in the self-sizing group. No significant differences were observed in rates of and time to CE-D and CE-IM.
These findings suggest that both systems are comparable in safety and efficacy. The use of the self-sizing system may enhance the efficiency of RFA for treating dysplastic Barrett's esophagus.
射频消融（RFA）是治疗发育不良性 Barrett 食管的首选消融方式。新引入的自尺寸环周消融导管消除了对尺寸球囊的需求。尽管它提高了效率，但尚未将其与以前的手动尺寸导管的结果进行比较。我们在一个大型多中心队列中评估了这两种消融系统的比较安全性和疗效。
纳入 2005 年至 2018 年在 3 个三级护理中心接受 RFA 的患者。以标准方式进行环周 RFA，然后根据需要进行焦点 RFA。比较自尺寸组和手动尺寸组之间的结果。主要结局是不良事件的发生率，包括狭窄、穿孔和出血。次要结局是程序时间和治疗效果，通过评估发育不良（CE-D）和肠上皮化生（CE-IM）完全消除的发生率和时间来评估。
共纳入 318 例患者，其中 90 例（28.3%）接受自尺寸导管治疗，228 例（71.7%）接受手动尺寸导管治疗。21 例（6.6%）发生狭窄（自尺寸组 8 [8.9%]，手动尺寸组 13 [5.7%]，P=.32）。自尺寸狭窄中有 75%发生在当前 10J 治疗标准广泛采用之前的 12J 剂量。1 例发生出血，无穿孔。自尺寸组的手术时间明显更短。CE-D 和 CE-IM 的发生率和时间无显著差异。
这些发现表明两种系统在安全性和疗效方面相当。使用自尺寸系统可能会提高 RFA 治疗发育不良性 Barrett 食管的效率。
