Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands.
Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Gut. 2022 Feb;71(2):265-276. doi: 10.1136/gutjnl-2020-322615. Epub 2021 Mar 22.
OBJECTIVE: Radiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett's oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting. DESIGN: Endoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included. RESULTS: After ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0-1; 1-2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22-69) and 4 endoscopies (1-5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk. CONCLUSION: In a setting of centralised care, RFA±ER is effective for eradication of Barrett's related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value. NETHERLANDS TRIAL REGISTER NUMBER: NL7039.
目的：射频消融（RFA）±内镜切除术（ER）是 Barrett 食管（BE）早期肿瘤的首选治疗方法。我们旨在报告 2008 年至 2018 年期间在荷兰（NL）接受治疗的 1384 例患者的短期和长期结果，这些患者在集中的环境中接受统一的治疗和随访（FU）。
设计：NL 中早期 BE 肿瘤的内镜治疗集中在 9 个具有专门培训的内镜医生和病理学家的专家中心，这些医生遵循联合协议。前瞻性收集的数据在统一的数据库中进行登记。低级别/高级别异型增生或低风险癌症患者接受可见病变的 ER 治疗，然后对任何残留的 BE 进行每三个月一次的 RFA 治疗，直到完全根除 BE（CE-BE）。未包括仅接受 ER 治疗的患者。
结果：在 ER 治疗（62%的病例；43%为低风险癌症）和中位数为 1 个环周和 2 个局灶性 RFA（p25-p75 0-1；1-2）后，94%（1270/1348）患者实现了 CE-BE。21%（268/1386）的患者发生不良事件，最常见的是食管狭窄（15%），所有这些均通过内镜治疗进行管理。对 1154 例 CE-BE 患者进行了长期结果分析。在中位数 43 个月（22-69）和 4 次内镜检查（1-5）期间，38 例患者出现异型增生复发（3%，年复发风险 1%），所有患者均通过内镜可见异常发现。在正常外观的贲门处随机活检显示肠化生（IM）占 14%，肿瘤占 0%。仅在 33%的患者中重现了贲门处的 IM 发现，且均未进展为肿瘤。在 FU 的第一年中频繁进行 FU 检查与复发风险无关。
结论：在集中治疗环境中，RFA±ER 是根除 Barrett 相关肿瘤的有效方法，其异型增生复发率非常低。我们的数据支持更宽松的 FU 间隔，重点是仔细的内镜检查。来自新鳞状上皮和贲门的随机活检价值值得怀疑。
荷兰临床试验注册号：NL7039。
United European Gastroenterol J. 2019-3-6
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