Endoscopy International Open, Inhaltsverzeichnis

CC BY 4.0 · Endosc Int Open 2020; 08(02): E189-E195
DOI: 10.1055/a-1005-6331

Original article

Owner and Copyright © Georg Thieme Verlag KG 2020

Standard versus simplified radiofrequency ablation protocol for Barrett’s esophagus: comparative analysis of the whole treatment pathway

Wei Keith Tan

¹MRC Cancer unit, University of Cambridge, Cambridge, UK

²Department of Gastroenterology, Addenbrookes Hospital, Cambridge, UK

,

Krish Ragunath

³NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK

⁴Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK

,

Jonathan R. White

³NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK

⁴Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK

,

Jose Santiago

³NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK

⁴Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK

,

Jacobo Ortiz Fernandez-Sordo

³NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK

⁴Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK

,

Mirela Pana

⁴Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK

,

Bincy Alias

¹MRC Cancer unit, University of Cambridge, Cambridge, UK

,

Andreas V. Hadjinicolaou

¹MRC Cancer unit, University of Cambridge, Cambridge, UK

²Department of Gastroenterology, Addenbrookes Hospital, Cambridge, UK

,

Vijay Sujendran

⁵Department of Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK

,

Massimiliano di Pietro

¹MRC Cancer unit, University of Cambridge, Cambridge, UK

› Institutsangaben

Abstract

Background and study aims The standard radiofrequency ablation (RFA) protocol for Barrett’s esophagus (BE) encompasses an intermediary cleaning phase between two ablation sessions. A simplified protocol omitting the cleaning phase is less labor-intensive but equally effective in studies based on single ablation procedures. The aim of this study was to compare efficacy and safety of the standard and simplified RFA protocols for the whole treatment pathway for BE, including both circumferential and focal devices.

Patients and methods We performed a retrospective analysis of prospectively collected data on patients receiving RFA between January 2007 and August 2017 at two institutions. Outcomes assessed were: 1) complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM) at 18 months; and 2) rate of esophageal strictures.

Results One hundred forty-five patients were included of whom 73 patients received the standard and 72 patients received the simplified protocol. CR-D was achieved in 94.5 % and 95.8 % of patients receiving the standard and simplified protocol, respectively (P = 0.71). CR-IM was achieved in 84.9 % and 77.8 % of patients treated with the standard and simplified protocol, respectively (P = 0.27). Strictures were significantly more common among patients who received the simplified protocol (12.5 %) compared to the standard protocol (1.4 %; P = 0.008). The median number of esophageal dilations was one.

Conclusion The simplified RFA protocol is as effective as the standard protocol in eradicating BE but carries a higher risk of strictures. This needs to be taken into account, particularly in patients with higher pretreatment risk of strictures, such as those with esophageal narrowing from previous endoscopic mucosal resection (EMR).

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