Weiss Simon, Pellat Anna, Corre Felix, Abou Ali Einas, Belle Arthur, Terris Benoit, Leconte Mahaut, Dohan Anthony, Chaussade Stanislas, Coriat Romain, Barret Maximilien
Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France.
Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France.
Clin Res Hepatol Gastroenterol. 2023 Jan;47(1):102065. doi: 10.1016/j.clinre.2022.102065. Epub 2022 Dec 6.
Radiofrequency ablation (RFA) has become the recommended endoscopic treatment for flat dysplastic Barrett's esophagus. However, the outcomes of this treatment are variable across European countries. Our aim was to report the results of a French high-volume center, and to investigate factors associated with treatment failure.
We conducted a single-center retrospective study from a prospectively collected database from 2011 to 2020, including all consecutive patients treated with RFA for flat dysplastic Barrett's esophagus. The primary endpoint was the failure rate of esophageal radiofrequency treatment, defined as either persistence of intestinal metaplasia at the end of treatment, or neoplastic progression during RFA.
96 patients treated with a median of four RFA sessions for a mean C5M6 Barrett's esophagus were included in the analysis. Complete eradication of intestinal metaplasia and dysplasia were achieved in 59% and 79% of patients, respectively, resulting in a treatment failure rate of 41%. Ten patients experienced neoplastic progression during treatment. We recorded 14% of post-RFA esophageal strictures, all successfully treated by endoscopic dilatation. Univariate analysis identified the length of Barrett's esophagus and the absence of hiatal hernia as predictive factors for treatment failure, however not confirmed in multivariate analysis.
In our experience, RFA of flat dysplastic Barrett's esophagus had a 41% treatment failure rate. The length of the Barrett's segment might be associated with treatment failure. Although our results confirm a role for RFA in the management of dysplastic Barrett's esophagus, the treatment failure rate was higher than expected. This suggest that endoscopists, even in high-volume centers, should receive specific training in RFA.
射频消融术（RFA）已成为治疗扁平发育异常的巴雷特食管的推荐内镜治疗方法。然而，在欧洲各国，这种治疗的效果存在差异。我们的目的是报告一家法国大型中心的治疗结果，并调查与治疗失败相关的因素。
我们对一个前瞻性收集的数据库进行了单中心回顾性研究，该数据库涵盖了2011年至2020年期间所有连续接受RFA治疗扁平发育异常巴雷特食管的患者。主要终点是食管射频治疗的失败率，定义为治疗结束时肠化生持续存在或RFA期间肿瘤进展。
分析纳入了96例平均接受4次RFA治疗的C5M6型巴雷特食管患者。分别有59%和79%的患者实现了肠化生和发育异常的完全根除，治疗失败率为41%。10例患者在治疗期间出现肿瘤进展。我们记录到14%的RFA后食管狭窄，均通过内镜扩张成功治疗。单因素分析确定巴雷特食管的长度和无食管裂孔疝是治疗失败的预测因素，但在多因素分析中未得到证实。
根据我们的经验，扁平发育异常巴雷特食管的RFA治疗失败率为41%。巴雷特段的长度可能与治疗失败有关。尽管我们的结果证实了RFA在发育异常巴雷特食管管理中的作用，但治疗失败率高于预期。这表明，即使在大型中心，内镜医师也应接受RFA的专门培训。
