Overwater Anouk, Elias Sjoerd G, Schoon Erik J, Bergman Jacques J G H M, Pouw Roos E, Weusten Bas L A M
Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Endoscopy. 2023 Mar;55(3):255-260. doi: 10.1055/a-1929-1448. Epub 2022 Sep 7.
Radiofrequency ablation (RFA) is effective for eradication of Barrett's esophagus (BE) neoplasia, but little is known on the course of pain and dysphagia after RFA. We aimed to describe the course of post-RFA symptoms and to identify possible associated risk factors.
In this multicenter, observational cohort study, all RFA procedures registered in a prospective database were included. Patient and treatment characteristics were collected from medical records and patients self-registered post-procedural symptoms in electronic symptom diaries for 14 days. Mixed model regression was used for the analyses.
In total, 255 diaries were completed. Post-RFA pain was reported for 95 % (95 %CI 93-98) of procedures (median duration 14 days; 25th-75th percentiles [p25-p75] 11-14) and major pain for 64 % (95 %CI 58-69; median duration 8 days, p25-p75 3-13). Post-procedural pain significantly increased with BE length, younger age, and no prior ablation. Dysphagia was present after 83 % (95 %CI 79-88) of procedures (median duration 13 days, p25-p75 9-14). The risk of dysphagia decreased with age and increased when patients experienced more pain.
RFA treatment for BE-related neoplasia seems a significant burden for patients, and post-procedural symptoms should be taken into account when counseling patients before starting endoscopic eradication therapy.
射频消融术（RFA）对根除巴雷特食管（BE）肿瘤有效，但关于RFA术后疼痛和吞咽困难的病程了解甚少。我们旨在描述RFA术后症状的病程，并确定可能的相关危险因素。
在这项多中心观察性队列研究中，纳入了前瞻性数据库中登记的所有RFA手术。从医疗记录中收集患者和治疗特征，并让患者在电子症状日记中自行记录术后14天的症状。采用混合模型回归进行分析。
共完成255份日记。95%（95%置信区间93 - 98）的手术报告了RFA术后疼痛（中位持续时间14天；第25 - 75百分位数[p25 - p75]为11 - 14），64%（95%置信区间58 - 69；中位持续时间8天，p25 - p75为3 - 13）报告了重度疼痛。术后疼痛随BE长度增加、年龄较小以及未进行过先前消融而显著增加。83%（95%置信区间79 - 88）的手术出现吞咽困难（中位持续时间13天，p25 - p75为9 - 14）。吞咽困难的风险随年龄降低，且在患者疼痛更严重时增加。
RFA治疗BE相关肿瘤对患者似乎是一个重大负担，在开始内镜根除治疗前咨询患者时应考虑术后症状。
