Radiofrequenzablation des Barrett-Ösophagus mit dem HALO-System

In den letzten Jahren hat sich die Radiofrequenzablation (RFA) des Barrett-Ösophagus mit dem HALO-System bestehend aus der Kombination einer zirkumferenziellen und einer fokalen Ablation etablieren können. Die RFA ist ein effektives und sicheres Verfahren mit niedriger Komplikationsrate, bewahrt die Funktionsfähigkeit des Ösophagus und ist leicht anwendbar. In diesem Artikel werden die technischen Aspekte des Verfahrens, die Durchführung der RFA, die Patientenselektion und die Ergebnisse klinischer Studien erläutert.

Schlüsselwörter

Barrett-Ösophagus - Radiofrequenzablation (RFA) - HALO-System (BARRX) - Barrett-Frühkarzinome - endoskopische Mukosa-resektion (EMR)

Literatur

• 1 Sharma P, Dent J, Armstrong D et al.. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria.  Gastroenterology. 2006;  131 1392-1399
• 2 Reid BJ, Blount PL, Feng Z et al.. Optimizing endoscopic biopsy detection of early cancers in Barrett's high-grade dysplasia.  Am J Gastroenterol. 2000;  95 3089-3096
• 3 Curvers WL, Singh R, Wong LM KeeSong et al.. Endoscopic trimodal imaging for detection of early neoplasia in Barrett's oesophagus; a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system.  Gut. 2008;  57 167-172
• 4 Aiko T, Sasako M. The new Japanese Classification of Gastric Carcinoma: Points to be revised.  Gastric Cancer. 1998;  1 25-30
• 5 Bergmann JJ. Endoscopic treatment of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus.  Best Pract Res Clin Gastroenterol. 2005;  19 889-907
• 6 Soehendra N, Seewald S, Groth S et al.. Use of modified multiband ligator facilitates circumferential EMR in Barrett's esophagus.  Gastrointest Endosc. 2006;  63 847-852
• 7 Gondrie JJ, Pouw RE, Sondermeijer CM et al.. Stepwise circumferential and focal ablation of Barrett's esophagus with high-grade dysplasia: results of the first prospective series of 11 patients.  Endoscopy. 2008;  40 359-369
• 8 Gondrie JJ, Pouw RE, Sondermeijer CM et al.. Effective treatment of early Barrett's neoplasia with stepwise circumferential and focal ablation using the HALO system.  Endoscopy. 2008;  40 370-379
• 9 Pouw RE, Sharma VK, Bergmann JJ et al.. Radiofrequency ablation for total Barrett's eradication: a description of the endoscopic technique, its clinical results and future prospects.  Endoscopy. 2008;  40 1033-1040
• 10 Pouw RE, Wirths K, Eisendrath P et al.. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett's esophagus with early neoplasia.  Clin Gastroenterol Hepatol. 2010;  8 23-29
• 11 Skacel M, Petras RE, Gramlich TL et al.. The diagnosis of low-grade-dysplasia in Barrett's esophagus and it implications for disease progression.  Am J Gastroenterol. 2000;  95 3383-3387
• 12 Curvers WL, ten FJ Kate, Krishnadath KK et al.. Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated.  Am J Gastroenterol. 2010;  7 1523-1530
• 13 Sharma VK, Kim HJ, Das A et al.. A prospective pilot trial of ablation of Barrett's esophagus with low-grade-dysplasia using stepwise circumferential and focal ablation (HALO system).  Endoscopy. 2008;  40 380-387
• 14 Shaheen NJ, Sharma P, Overholt BF et al.. Radiofrequency ablation in Barrett's esophagus with dysplasia.  N Engl J Med. 2009;  22 2277-2288
• 15 Fleischer DE, Odze R, Overholt BF et al.. The case of endoscopic treatment of non-dysplastic and low-grade dysplastic Barrett's esophagus.  Dig Dis Sci. 2010;  7 1918-1931
• 16 Shaheen NJ, Crosby MA, Bozymski EM et al.. Is there a publication bias in the reporting of cancer risk in Barrett's esophagus?.  Gastroenterology. 2000;  119 333-338
• 17 Sharma P, Faulk GW, Weston AP et al.. Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus.  Clin Gastroenterol Hepatol. 2006;  4 566-572
• 18 Sharma VK, Wang KK, Overholt BF et al.. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients.  Gastrointest Endosc. 2007;  65 185-195
• 19 Fleischer DE, Overholt BF, Sharma VK et al.. Endoscopic ablation of Barrett's esophagus: a multicenter study with 2.5-year follow-up.  Gastrointest Endosc. 2008;  68 867-876
• 20 Fleischer DE, Overholt BF, Sharma VK et al.. Endoscopic radiofrequency ablation for Barrett's esophagus: 5-year outcomes from a prospective multicenter trial.  Endoscopy. 2010;  10 781-789
• 21 Pouw RE, Gondrie JJ, Rygiel AM et al.. Properties of the neosquamous epithelium after radiofrequency ablation of Barrett's esophagus containing neoplasia.  Am J Gastroenterol. 2009;  104 1366-1373
• 22 Beaumont H, Gondrie JJ, McMahon BP et al.. Stepwise radiofrequency ablation of Barrett's esophagus preserves esophageal inner diameter, compliance, and motility.  Endoscopy. 2009;  41 2-8

Korrespondenzadresse