PMID- 23108809
OWN - NLM
STAT- MEDLINE
DCOM- 20130517
LR  - 20220309
IS  - 1438-8812 (Electronic)
IS  - 0013-726X (Linking)
VI  - 44
IP  - 12
DP  - 2012 Dec
TI  - Radiofrequency ablation and endoscopic resection in a single session for 
      Barrett's esophagus containing early neoplasia: a feasibility study.
PG  - 1096-104
LID - 10.1055/s-0032-1325731 [doi]
AB  - BACKGROUND AND STUDY AIM: Endoscopic resection with radiofrequency ablation (RFA) 
      6 weeks later safely and effectively eradicates Barrett's esophagus with high 
      grade dysplasia (HGD) and early cancer. After widespread endoscopic resection, 
      related scarring may hamper balloon-based circumferential RFA (c-RFA). However 
      c-RFA immediately followed by endoscopic resection in the same session might 
      avoid the impact of scarring and reduce laceration and stenosis risk. We aimed to 
      assess the feasibility of such an approach. PATIENTS AND METHODS: Patients with 
      Barrett's esophagus >/= 3 cm and >/= 1 visible lesion (HGD/early cancer) were 
      included. Visible lesions were marked with cautery, and c-RFA (12 J/cm2) was 
      delivered using two applications and a cleaning step, followed by resection of 
      the delineated area. Outcome measures were surface regression of Barrett's 
      esophagus at 3 months, need for subsequent c-RFA, complications, and quality of 
      resection specimens. RESULTS: 24 patients (20 men, 4 women; mean age 68 years, 
      standard deviation [SD] 12; Barrett's esophagus median length C6M8) underwent 
      single-session c-RFA + endoscopic resection, providing a median of 4 
      (interquartile range [IQR] 2 - 6) resection specimens (early cancer 18 patients; 
      HGD 6). Complications included 1 perforation, 4 bleedings, and 5 stenoses; all 
      were managed endoscopically. Specimens allowed assessment of neoplasia depth, 
      differentiation, and lymphatic/vascular invasion. Median Barrett's esophagus 
      surface regression at 3 months was 95 %. No patient required a second c-RFA 
      procedure and 40 % required repeat endoscopic resection for visible lesions. 
      Complete response for neoplasia was achieved in 100 % and complete response for 
      intestinal metaplasia (CR-IM) in 95 %. CONCLUSIONS: c-RFA followed by endoscopic 
      resection in the same session is feasible, but technically demanding and 
      associated with a substantial rate of complications and repeat endoscopic 
      resection. This approach should be reserved for selected cases in expert centers, 
      with endoscopic resection and RFA 6 - 8 weeks later remaining the standard 
      combined approach.
FAU - van Vilsteren, F G I
AU  - van Vilsteren FG
AD  - Department of Gastroenterology, Academic Medical Center, Amsterdam, Netherlands.
FAU - Alvarez Herrero, L
AU  - Alvarez Herrero L
FAU - Pouw, R E
AU  - Pouw RE
FAU - Visser, M
AU  - Visser M
FAU - Ten Kate, F J W
AU  - Ten Kate FJ
FAU - van Berge Henegouwen, M I
AU  - van Berge Henegouwen MI
FAU - Schoon, E J
AU  - Schoon EJ
FAU - Weusten, B L
AU  - Weusten BL
FAU - Bergman, J J
AU  - Bergman JJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121029
PL  - Germany
TA  - Endoscopy
JT  - Endoscopy
JID - 0215166
SB  - IM
CIN - Endoscopy. 2013 Jun;45(6):507. PMID: 23733733
MH  - Aged
MH  - Barrett Esophagus/*pathology/surgery
MH  - Biopsy, Needle
MH  - Catheter Ablation/*methods
MH  - Combined Modality Therapy
MH  - Confidence Intervals
MH  - Esophageal Neoplasms/*pathology/*surgery
MH  - Esophagoscopy/*methods
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunohistochemistry
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/methods
MH  - Netherlands
MH  - Precancerous Conditions/*pathology/surgery
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Tertiary Care Centers
MH  - Treatment Outcome
EDAT- 2012/10/31 06:00
MHDA- 2013/05/18 06:00
CRDT- 2012/10/31 06:00
PHST- 2012/10/31 06:00 [entrez]
PHST- 2012/10/31 06:00 [pubmed]
PHST- 2013/05/18 06:00 [medline]
AID - 10.1055/s-0032-1325731 [doi]
PST - ppublish
SO  - Endoscopy. 2012 Dec;44(12):1096-104. doi: 10.1055/s-0032-1325731. Epub 2012 Oct 
      29.