Gotink Annieke W, Peters Yonne, Bruno Marco J, Siersema Peter D, Koch Arjun D
Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Endoscopy. 2022 Jun;54(6):545-552. doi: 10.1055/a-1644-4326. Epub 2021 Dec 21.
Several techniques exist for the eradication of Barrett's esophagus (BE); however, all have limitations regarding successful conversion to squamous epithelium and a complication profile. We aimed to assess the feasibility and safety of a new nonthermal device, the EndoRotor, for the eradication of BE as a first-line ablation technique.
Patients with BE were prospectively included at two tertiary referral centers in The Netherlands.
BE length 2-5 cm, with low grade dysplasia, high grade dysplasia, or residual BE after endoscopic resection (ER) of a lesion containing early neoplasia.
previous ER > 50 % circumference, or previous ablation therapy. Follow-up endoscopy was performed 3 months after ablation therapy. Outcomes were the percentage of endoscopically visible BE surface regression and complications.
30 patients were included (age 66 years, interquartile range [IQR] 59-73, median BE C0M3, 25 male). Overall, 18 patients underwent ER prior to ablation. Median percentage BE ablated was 100 % (IQR 94 %-100 %). Median visual BE surface regression at 3-month follow-up was 80 % (IQR 68 %-95 %). Multiple residual Barrett's islands were commonly seen. Six patients (20 %) had a treatment-related complication requiring intervention, including one perforation (3 %), one postprocedural hemorrhage (3 %), and four strictures (13 %). Post-procedural pain was reported in 18 patients (60 %).
Endoscopic ablation of BE using this novel nonthermal device was found to be technically demanding, with a longer procedure time compared with established ablation techniques and a high complication rate. Based on these results, we do not recommend its use as a first-line ablation technique for the eradication of BE.
目前有多种技术可用于根除巴雷特食管（BE）；然而，在成功转化为鳞状上皮以及并发症方面，所有技术都存在局限性。我们旨在评估一种新型非热装置EndoRotor作为一线消融技术根除BE的可行性和安全性。
在荷兰的两个三级转诊中心前瞻性纳入了BE患者。
BE长度为2 - 5厘米，伴有低级别异型增生、高级别异型增生，或在对包含早期肿瘤的病变进行内镜切除（ER）后残留BE。
既往ER超过50%周径，或既往接受过消融治疗。消融治疗后3个月进行随访内镜检查。结果指标为内镜可见的BE表面消退百分比和并发症情况。
纳入30例患者（年龄66岁，四分位间距[IQR]为59 - 73，BE中位数C0M3，25例男性）。总体而言，18例患者在消融前接受了ER。消融的BE中位数百分比为100%（IQR 94% - 100%）。3个月随访时内镜下BE表面消退的中位数为80%（IQR 68% - 95%）。常见多个残留的巴雷特岛。6例患者（20%）发生需要干预的治疗相关并发症，包括1例穿孔（3%）、1例术后出血（3%）和4例狭窄（13%）。18例患者（60%）报告有术后疼痛。
使用这种新型非热装置对BE进行内镜消融在技术上要求较高，与既定的消融技术相比手术时间更长且并发症发生率高。基于这些结果，我们不建议将其用作根除BE的一线消融技术。
