Navigation Links
Endoscopic circumferential ablation promising for Barrett's esophagus with high-grade dysplasia
Date:7/31/2008

OAK BROOK, Ill. July 31, 2008 A multicenter U.S. registry study examining the treatment of Barrett's esophagus (BE) with high-grade dysplasia (HGD) showed that in 92 patients treated with endoscopic circumferential ablation who had at least one follow-up biopsy session, 90.2 percent were free of HGD at an average of one-year follow-up. This registry is the first to report on the use of circumferential ablation for BE HGD. The study appears in the July issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Barrett's esophagus is a condition where the lining of the esophagus changes because of chronic inflammation, generally due to gastroesophageal reflux disease (GERD). Definitive diagnosis requires a biopsy, taken at upper endoscopy, demonstrating replacement of the normal cell lining with one more like the cell lining of the small intestine. This is also known as intestinal metaplasia (IM). Barrett's esophagus itself has no specific symptoms, but this change can increase the risk of esophageal adenocarcinoma (a type of esophageal cancer). Barrett's esophagus can be readily detected during an upper endoscopy, but must be confirmed by biopsies. The intent is to diagnose this condition, treat it medically, and follow it over time before a cancer has a chance to develop. If biopsies detect dysplasia (a precancerous change in tissue), then either surgery, close endoscopic surveillance (doing endoscopies at regular intervals with biopsies) or other treatments will be recommended. Once high-grade dysplasia is present, the risk of developing adenocarcinoma is two percent to 10 percent per patient, per year. Given the rising incidence of esophageal adenocarcinoma and the poor prognosis once cancer develops, aggressive therapy of the precancerous changes may be beneficial.

"This patient registry assessed the safety and effectiveness of endoscopic circumferential balloon-based ablation using radiofrequency energy for the treatment of BE HGD at 16 U.S. academic and community institutions," said study lead author Robert A. Ganz, MD, FASGE, Minnesota Gastroenterology, Minneapolis. "Results were promising, showing that 90.2 percent of patients were free of high-grade dysplasia at an average of one-year follow-up and avoided many of the adverse events associated with other modalities currently used with this disease."

Patients who have BE with HGD have historically been referred for surgical removal of the esophagus. However, over the last several years alternative therapies for these patients have been pursued given the risks of surgery. These therapies include endoscopic mucosal resection (EMR), endoscopic ablation by using photodynamic therapy (PDT), and a myriad of other thermal and nonthermal modalities. Each therapeutic strategy has specific limitations, such as technical complexity of the procedure itself, stricture formation leaving behind buried Barrett's esophagus, photosensitivity, and stricture formation.

The primary benefit shared by the endoscopic techniques is esophageal preservation, whereas esophagectomy has merit because of resection of the entire organ, which allows for complete histologic assessment and removal of all the at-risk tissue. Circumferential ablation with a balloon-based radiofrequency device is a more recently available endoscopic ablation technique for BE HGD. This procedure burns away the abnormal cells with radiofrequency energy.

Patients and Methods

A total of 142 patients (median age 66 years) at 16 academic and community centers in the U.S. were enrolled in the registry from September 2004 to March 2007. Patients had histologic evidence of IM that contained HGD confirmed by at least two expert pathologists. A prior EMR was permitted provided that residual HGD remained in the BE region for ablation.

The endoscopic circumferential ablations were performed with a balloon-based radiofrequency energy electrode array catheter introduced in a side-by-side manner with an endoscope. The procedures were performed on an outpatient basis. After the primary ablation session, patients underwent an endoscopy at three-month intervals. If persistent BE was evident, then another circumferential ablation was performed. The outcomes were histology based and derived from the last available endoscopy with a biopsy session. Three separate outcomes were measured: presence/absence of HGD, presence/absence of any dysplasia, presence/absence of IM, including IM buried beneath the normal esophageal lining.

Results

In these 142 patients treated with circumferential ablation for BE with HGD, 92 patients had at least one follow-up biopsy session (median follow-up twelve months) and were evaluated for effectiveness. 90.2 percent were free of HGD; 80.4 percent were free of any dysplasia; and 54.3 percent were free of IM. No serious adverse events occurred in the safety analysis cohort. Esophageal stricture occurred in one patient (.4 percent).

The authors concluded that circumferential ablation is a promising modality for the treatment of Barrett's esophagus with high-grade dysplasia and the technique compares favorably with PDT, wide-field EMR, and esophagectomy, with respect to safety, patient tolerability, and the histologic complete response outcomes tracked. Further, there may also be an adjunctive role for circumferential ablation and EMR, with EMR used to remove visible abnormalities for staging followed by circumferential ablation to eliminate all remaining dysplastic and metaplastic disease.

The study acknowledges some limitations, including a nonrandomized study design, but demonstrates a real-life experience on the use of this ablative modality in the management of BE HGD. Researchers also noted that additional studies are underway to confirm these registry results.


'/>"/>

Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

Related medicine news :

1. Portable Endoscopic Company Announces Hiring of David Guy as COO/President
2. How to use endoscopic stent for biliary stricture trauma?
3. joimax(R) Revolutionizes Spine Surgery With the Launch of Newest and Fully-Endoscopic Product Innovations to Treat Spinal Canal Stenosis
4. ASGE offers guidelines on endoscopic treatment of dyspepsia
5. Endoscopic resection is a safe and effective treatment for gastrointestinal smooth muscle tumors
6. Precancerous Esophagus Disease Eliminated in 98.4% of Patients Treated With HALO Ablation System
7. Radiofrequency ablation is effective treatment for dysplasia in Barretts esophagus
8. BioForm Medical Acquires Facial Aesthetic Nerve Ablation Technology
9. ATS Medical Announces First Frontiers in Cryoablation Symposium
10. AtriCures Coolrail(TM) Linear Ablation Pen Receives FDA 510(k) Clearance
11. St. Davids Medical Center First in Texas to Implement Visually Guided Catheter Ablation for Atrial Fibrillation
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/25/2016)... ... 25, 2016 , ... Casa Velas, an adults-only boutique hotel in Puerto Vallarta, ... its new wellness suites . The two 1,350 sq. ft. suites which debuted ... services and insuite amenities, from a custom soap selection and in-suite exercise kit to ...
(Date:5/25/2016)... , ... May 25, 2016 , ... America Walks ... Carol Reichbaum, M.S.L., M.S.P.A., of the University of Pittsburgh Graduate School of Public ... will enable Ms. Reichbaum and 24 other advocates from around the country to participate ...
(Date:5/25/2016)... ... May 25, 2016 , ... "FCPX LUT Intense allows ... your footage," said Christina Austin - CEO of Pixel Film Studios. , With ... and easily add stylish color grades to their footage. A LUT is a Lookup ...
(Date:5/25/2016)... ... May 25, 2016 , ... Consumer access to organic foods ... 2016, Kashi®, a maker of whole grain cereals and other plant-based foods, will introduce ... hard red winter wheat processed by Hesco/Dakota Organic Products. , The transitional designation ...
(Date:5/25/2016)... (PRWEB) , ... May 25, 2016 , ... Stern ... firm will be selling the device branded as Stern’s Real Time Monitoring ... to bedbugs to the hotel and motel industry, colleges for use in dormitories, shelters, ...
Breaking Medicine News(10 mins):
(Date:5/24/2016)... May 24, 2016 Een app ... zodat zij collectief patiënten kunnen behandelen, hun kennis kunnen ... idee achter de nieuwe en revolutionaire MDLinking App, ontwikkeld ... Nederlandse vaatchirurg dr. Hans Flu en oncologisch chirurg dr. ... inmiddels beschikbaar is, wordt op dinsdag 24 mei officieel ...
(Date:5/23/2016)... FLINT, Mich. , May 23, 2016 Diplomat ... the third annual Fellowship and Internship programs. The hands-on ... 12. The full-time, paid Fellowship ... Flint, Michigan . Fellows and interns are ... downtown Flint at the Riverfront ...
(Date:5/23/2016)... , May 23, 2016 ... Devices, Diagnostics and Monitoring, and Vision Care ... Which areas are going to grow at the fastest ... revenues to 2026, assessing data, trends, opportunities and prospects. ... charts, and graphs. Discover the most lucrative areas in ...
Breaking Medicine Technology: