Godat Sébastien, Marx Mariola, Caillol Fabrice, Robert Maxime, Autret Aurélie, Bories Erwan, Pesenti Christian, Ratone Jean Philippe, Schoepfer Alain, Poizat Flora, Giovannini Marc
Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Sébastien Godat, Mariola Marx, Maxime Robert, Alain Schoepfer).
Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France (Fabrice Caillol, Erwan Bories, Jean Philippe Ratone, Marc Giovannini).
Ann Gastroenterol. 2022 Jan-Feb;35(1):34-41. doi: 10.20524/aog.2021.0685. Epub 2021 Dec 6.
High-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in Barrett's esophagus (BE) are now well-established indications for endoscopic resection (ER). Radiofrequency ablation (RFA) can be combined with ER in case of flat or long-segment BE ablation. We report here our experience of complementary RFA after widespread ER of neoplastic BE in daily practice.
We retrospectively reviewed data of 89 patients, treated between 2006 and 2013 by ER alone (group 1) or by ER combined with RFA (group 2).
Fifty-five patients in group 1 (7F/48M, mean age 68 years) underwent widespread ER with eradication of residual non-dysplastic BE. Complete eradication of HGD/IMC and intestinal metaplasia (IM) was achieved in 32/32 (100%) and 48/55 (87.3%) patients, respectively. Thirty-four patients in group 2 (3F/31M, mean age 67 years) had a multimodal treatment strategy, with widespread ER followed by RFA. Mean Prague classification of BE in this group was significantly longer (C4.4M6.6 vs. C2.7M4.5, P<0.001). Complete eradication of HGD/IMC and non-dysplastic BE was confirmed in 26/27 (96.3%) and 20/34 (58.8%) patients, respectively. There was no significant difference between groups concerning adverse events (16.4% vs. 23.5%, P=0.58) or recurrence rate of HGD/IMC (9.1% vs. 14.7%, P=0.42). The mismatch rate between preoperative and final histological diagnosis was high in both groups, at 45.5% and 26.5%.
A combination of ER and RFA can treat significantly longer neoplastic BE than ER alone, with the same efficiency and safety. Widespread ER, in contrast, is the only method of obtaining a reliable histological diagnosis.
巴雷特食管（BE）中的高级别异型增生（HGD）和黏膜内癌（IMC）目前已成为内镜切除术（ER）的确切适应证。对于扁平或长段BE消融，可将射频消融（RFA）与ER联合应用。在此，我们报告在日常实践中对肿瘤性BE广泛进行ER后补充RFA的经验。
我们回顾性分析了2006年至2013年间接受单纯ER（第1组）或ER联合RFA（第2组）治疗的89例患者的数据。
第1组的55例患者（7例女性/48例男性，平均年龄68岁）接受了广泛的ER，残余的非异型增生性BE得以根除。分别在32/32例（100%）和48/55例（87.3%）患者中实现了HGD/IMC和肠化生（IM）的完全根除。第2组的34例患者（3例女性/31例男性，平均年龄67岁）采用了多模式治疗策略，即先进行广泛的ER，然后进行RFA。该组BE的平均布拉格分类明显更长（C4.4M6.6 vs. C2.7M4.5，P<0.001）。分别在26/27例（96.3%）和20/34例（58.8%）患者中证实了HGD/IMC和非异型增生性BE的完全根除。两组在不良事件（16.4% vs. 23.5%，P = 0.58）或HGD/IMC复发率（9.1% vs. 14.7%，P = 0.42）方面无显著差异。两组术前与最终组织学诊断之间的不匹配率均较高，分别为45.5%和26.5%。
与单纯ER相比，ER与RFA联合应用可治疗更长范围的肿瘤性BE，且效率和安全性相同。相比之下，广泛的ER是获得可靠组织学诊断的唯一方法。
