Predictive factors of radiofrequency ablation failure in the treatment of dysplastic Barrett's esophagus - 07/01/23
Highlights |
• | Radiofrequency ablation for dysplastic Barrett's esophagus achieved only 59% complete eradication of intestinal metaplasia in our study. |
• | 10% of the patients experienced neoplastic progression during treatment, and 14% developed esophageal strictures, all successfully treated by endoscopic dilatation. |
• | The length of Barrett's esophagus was associated with failure to reach complete eradication of intestinal metaplasia. |
• | A specific training and a high case load per endoscopist seem mandatory to achieve acceptable results in radiofrequency ablation for Barrett's esophagus. |
Abstract |
Introduction |
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.
Methods |
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.
Results |
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.
Conclusion |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Barrett's esophagus, Early esophageal adenocarcinoma, Radiofrequency ablation
Esquema
Vol 47 - N° 1
Artículo 102065- janvier 2023 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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