Navigation Links
Radiofreqeuncy ablation and complete endoscopic resection equally effective for dysplastic Barrett's esophagus
Date:5/21/2014

DOWNERS GROVE, Ill. May 21, 2014 According to a new systematic review article, radiofrequency ablation and complete endoscopic resection are equally effective in the short-term treatment of dysplastic Barrett's esophagus, but adverse event rates are higher with complete endoscopic resection. The article comparing the two treatments appears in the May 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 in which the lining of the esophagus changes and becomes more like the lining of the small intestine. It is believed that Barrett's esophagus (BE) occurs because of chronic inflammation resulting from long-standing Gastroesophageal Reflux Disease (GERD). Barrett's esophagus is more common in Caucasian males older than the age of 50 who have had GERD for greater than five years. Most patients with Barrett's esophagus will not develop cancer. However, in some patients further precancerous change in the tissue, called dysplasia, will develop. Those patients that develop dysplasia, especially high grade dysplasia, are significantly more likely to develop esophageal cancer.

Esophagectomy (surgery to remove part or all of the esophagus) has previously been the recommended treatment for BE with high grade dysplasia (HGD) or intramucosal cancer (cancer limited to the most superficial layer of the esophagus), but this surgery is associated with significant morbidity and mortality. As a result, endoscopic therapies for treatment of HGD or superficial cancers have been developed which minimize treatment-related morbidity. Ideally, endoscopic treatments need to target the entire segment of Barrett's mucosa (lining of the esophagus) in order to maximally reduce the risk of developing esophageal cancer.

To date, two distinct endoscopic approaches have been widely used for this purpose. The first is complete endoscopic mucosal resection (EMR) where the BE mucosa is resected or removed endoscopically. This has the advantage of providing a large histologic specimen, which can then be evaluated for unrecognized, more advanced pathology, and may be curative. The other approach is ablation of the BE mucosa by using a variety of techniques such as photodynamic therapy, argon plasma coagulation (APC), and more recently, radiofrequency ablation (RFA). RFA uses a focal heat process to destroy the Barrett's tissue. In recent years, RFA has become the ablative treatment of choice in the management of dysplastic BE, with early studies suggesting excellent efficacy and low rates of adverse events.

"Only one trial to date has directly compared complete EMR and RFA in treating dysplastic BE. The aim of this systematic review was to compare the efficacy and safety of these two techniques. This is important because RFA is substantially more expensive than complete EMR and may require multiple procedures over six months or more, making it less acceptable to patients. Therefore, in order to justify the use of RFA in the future it must be convincingly proven to be superior to complete EMR, in terms of both efficacy and risk of adverse events," said study lead author Georgina Chadwick, MRCP, The Royal College of Surgeons of England. "We found that RFA and complete EMR are equally effective in the short-term treatment of dysplastic BE, but adverse event rates are higher with complete EMR."

Methods

This article was a systematic review of literature to compare the efficacy and safety of complete EMR and radiofrequency ablation in the treatment of dysplastic BE. Patients had a diagnosis of BE with HGD or intramucosal cancer treated with either complete EMR or RFA. Main outcome measurements included complete eradication of dysplasia and intestinal metaplasia at the end of treatment and after more than 12 months' follow-up, as well as short and long-term adverse event rates associated with either treatment.

Results

A total of 22 studies met the inclusion criteria. Only one trial directly compared the two techniques; most studies were observational case series. Dysplasia was effectively eradicated at the end of treatment in 95 percent of patients after complete EMR and 92 percent after RFA. After a median follow-up of 23 months for complete EMR and 21 months for RFA, eradication of dysplasia was maintained in 95 percent of patients treated with complete EMR and 94 percent of patients treated with RFA. Short-term adverse events were seen in 12 percent of patients treated with complete EMR, but in only 2.5 percent of those treated with RFA. Esophageal strictures were long-term adverse events in 38 percent of patients treated with complete EMR, compared with 4 percent of those treated with RFA. Progression to cancer appeared to be rare after either treatment, although follow-up was short.

The authors concluded that both complete EMR and RFA have proven efficacy in eradication of BE with HGD or intramucosal cancer, but both short and long-term adverse events are significantly greater after complete EMR. The results of this review suggest that RFA, with prior resection of any nodules, is the endoscopic treatment of choice for dysplastic BE. But further research needs to be done to prove the long-term durability of both treatments in order to confirm their superiority over surgery in the management of dysplastic BE. Though low, the risk of recurrence of dysplasia and intestinal metaplasia after treatment reiterates the need for continuing endoscopic surveillance. Further research needs to determine the optimal surveillance regimen after successful eradication.


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

Related medicine news :

1. Researchers destroy cancer with cryoablation & nanoparticle-encapsulated anticancer drug
2. One-quarter of high risk patients denied anticoagulation after AF ablation
3. Ablation Technologies Market (Radiofrequency, Cryoablation, Ultrasound, Hydrothermal) Worth $12.4 Billion by 2016 - New Report by MarketsandMarkets
4. Ablation Devices Market Worth $12.4 Billion by 2016 - New Report by MarketsandMarkets
5. Pain Management Devices Market (Electrical Stimulators, Radiofrequency Ablation, Analgesic Pumps, Neurostimulation Devices) - Global Trends And Forecast, 2012 - 2018
6. Radiofrequency ablation effectively treats Barretts esophagus
7. Magnetic resonance imaging before ablation for atrial fibrosis helps predict success of treatment
8. Ablation Technologies Market (Radiofrequency, Cryoablation, Microwave) Worth $12.4 Billion by 2016 – New Report by MarketsandMarkets
9. Radiofrequency Ablation Devices Market is Expected to Reach USD 1.0 Billion Globally in 2018: Transparency Market Research
10. GAP-AF study helps to define optimal approach to ablation
11. New ablation technique holds promise for liver cancer patients
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/31/2016)... ... May 31, 2016 , ... To meet a ... the healthcare industry, The University of Scranton is adding a Certificate in Health ... a career in rapidly growing field of healthcare information. , Healthcare organizations ...
(Date:5/30/2016)... Salt Lake City, Utah (PRWEB) , ... May ... ... health insurance reimbursement for small businesses, announced today the publication of an original ... helps business owners and health insurance professionals understand how Zane Benefits complies with ...
(Date:5/29/2016)... ... 29, 2016 , ... "With 30 unique self-animating web themed intros and complete ... their project," said Christina Austin - CEO of Pixel Film Studios. , ProIntro ... use in Final Cut Pro X. Pixel Film Studios’ minimalistic titles allow users to ...
(Date:5/28/2016)... ... ... a part of the city where’s it’s easy to spot the neon lights of chains ... to attract diners with a taste for real food. , On May 13, the ... Grill, an urban casual restaurant focusing on dishes made by hand with wholesome, organic ingredients ...
(Date:5/27/2016)... , ... May 27, 2016 , ... An influential resource ... a third time to shed lights on the variety of topics detailing why we ... “Nurse Appreciation” tackles why this career has gone from being in a major recession ...
Breaking Medicine News(10 mins):
(Date:5/27/2016)... , May 27, 2016 ... the Dario™ Diabetes Management Tool, today announced that the Company,s ... the Marcum MicroCap Conference being held June 1-2 in ... Invitational, being held June 7-9 in Los Angeles, ... will discuss recent corporate and operational milestones, including the U.S. ...
(Date:5/27/2016)... 27, 2016 The healthcare sector ... insurance companies all falling under its umbrella.  A rather ... not often talked about, these healthcare companies are still ... is by far the largest consumer of ... Corp. (OTC: ADMD), Nutranomics Inc. (OTC: NNRX), KollagenX Corp. ...
(Date:5/26/2016)... 26, 2016 Since its commercial ... an essential life science tool for conducting genetic studies ... Research reveals in its new report that the industry ... one powered by a range of new applications in ... (Logo: http://photos.prnewswire.com/prnh/20140723/694805 ) , Since ...
Breaking Medicine Technology: