Recurrence of Esophageal Intestinal Metaplasia After Endoscopic Mucosal Resection and Radiofrequency Ablation of Barrett's Esophagus: Results From a US Multicenter Consortium

被引：175

作者：

Gupta, Milli ^{[1
]}

Iyer, Prasad G. ^{[1
]}

Lutzke, Lori ^{[1
]}

Gorospe, Emmanuel C. ^{[1
]}

Abrams, Julian A. ^{[2
]}

Falk, Gary W. ^{[3
]}

Ginsberg, Gregory G. ^{[3
]}

Rustgi, Anil K. ^{[3
]}

Lightdale, Charles J. ^{[2
]}

Wang, Timothy C. ^{[2
]}

Fudman, David I. ^{[2
]}

Poneros, John M. ^{[2
]}

Wang, Kenneth K. ^{[1
]}

机构：

[1] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA

[2] Columbia Univ, Med Ctr, Div Digest & Liver Dis, New York, NY USA

[3] Univ Penn, Perelman Sch Med, Div Gastroenterol, Philadelphia, PA 19104 USA

来源：

GASTROENTEROLOGY | 2013年 / 145卷 / 01期

基金：

美国国家卫生研究院;

关键词：

Esophageal Cancer; Prevention; Endoscopic Therapy; EAC; HIGH-GRADE DYSPLASIA; FOCAL ABLATION; EARLY NEOPLASIA; ERADICATION; ADENOCARCINOMA; SURVEILLANCE; REGISTRY;

D O I：

10.1053/j.gastro.2013.03.008

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett's esophagus (BE). Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA. METHODS: We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastroesophageal junction biopsy specimens), documented by 2 consecutive endoscopies. Recurrence was defined as the presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. RESULTS: Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic BE. Of patients treated, 448 (76%) were assessed after RFA. Fifty-five percent of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication. CONCLUSIONS: Of patients with BE treated by RFA, 56% were in complete remission after 24 months. However, 33% of these patients had disease recurrence within the next 2 years. Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after RFA is essential.

引用

页码：79 / +

页数：9

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