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

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

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