Bahdi Firas, Katti Chafik Clement, Mansour Nabil, Gagneja Harish, Anandasabapathy Sharmila, Othman Mohamed O
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.
Scand J Gastroenterol. 2023 Feb;58(2):123-132. doi: 10.1080/00365521.2022.2111226. Epub 2022 Aug 14.
Although Endoscopic Submucosal Dissection (ESD) was proven superior to Endoscopic Mucosal Resection (EMR) in achieving higher complete remission rates for neoplastic Barrett's Esophagus (BE), its safety with Radiofrequency Ablation (RFA) remains unstudied. We share our experience with ESD + RFA for nodular BE eradication.
A retrospective study of all patients ≥18-years with nodular BE who underwent ESD + RFA between September 2015 and December 2020 at our tertiary center. Patients with advanced adenocarcinoma requiring esophagectomy were excluded. Primary outcomes included adverse events (AE) rates and complete eradication rates for adenocarcinoma (CE-EAC), dysplasia (CE-D), and intestinal metaplasia (CE-IM). Secondary outcomes included local recurrence rates following eradication.
Eighteen patients were included with a total of 22 ESDs performed and a median of 2 RFA sessions-per-patient [IQR: 1.25, 3]. Sixteen patients were males and/or white (88.9%) with a median BMI of 29.75 kg/m [IQR: 26.9, 31.5]. Fourteen patients had long-segment BE (77.7%) while 16 had hiatal hernias (88.9%). Median resection size was 12.1 cm [IQR: 5.6, 20.2]. AEs included one intraprocedural micro-perforation (4.5%) and 4 strictures (22.2%), only one of which developed post-RFA. All AEs were successfully treated endoscopically. Over a median of 42.5 months [IQR: 28, 59.25], CE-EAC was achieved in 13 patients (100%), CE-D in 15 patients (100%), and CE-IM in 14 patients (77.8%). Following eradication, 2 patients had recurrent dysplasia (2/15, 13.3%) and one had recurrent intestinal metaplasia (1/14, 7.1%).
In high-risk patients with long-segment neoplastic BE requiring extensive endoscopic resection, ESD + RFA offers excellent complete eradication rates with rare additional adverse events by RFA. Standard endoscopic surveillance following eradication remains important.
尽管内镜黏膜下剥离术（ESD）在实现肿瘤性巴雷特食管（BE）更高的完全缓解率方面已被证明优于内镜黏膜切除术（EMR），但其与射频消融术（RFA）联合应用的安全性仍未得到研究。我们分享我们应用ESD+RFA根除结节性BE的经验。
对2015年9月至2020年12月在我们三级中心接受ESD+RFA的所有年龄≥18岁的结节性BE患者进行回顾性研究。排除需要行食管切除术的晚期腺癌患者。主要结局包括不良事件（AE）发生率以及腺癌完全根除率（CE-EAC）、异型增生完全根除率（CE-D）和肠化生完全根除率（CE-IM）。次要结局包括根除后的局部复发率。
纳入18例患者，共进行了22次ESD，每位患者平均接受2次RFA治疗[四分位间距：1.25，3]。16例患者为男性和/或白人（88.9%），中位体重指数为29.75kg/m²[四分位间距：26.9，31.5]。14例患者有长段BE（77.7%），16例有食管裂孔疝（88.9%）。中位切除大小为12.1cm[四分位间距：5.6，20.2]。不良事件包括1例术中微小穿孔（4.5%）和4例狭窄（22.2%），其中只有1例在RFA后发生。所有不良事件均通过内镜成功治疗。在中位42.5个月[四分位间距：28，59.25]的随访期内，13例患者（100%）实现了CE-EAC，15例患者（100%）实现了CE-D，14例患者（77.8%）实现了CE-IM。根除后，2例患者出现异型增生复发（2/15，13.3%），1例患者出现肠化生复发（1/14，7.1%）。
对于需要广泛内镜切除的长段肿瘤性BE高危患者，ESD+RFA提供了优异的完全根除率，且RFA带来的额外不良事件罕见。根除后进行标准的内镜监测仍然很重要。
