283 Patients Undergoing Radiofrequency Ablation (RFA) for Barrett's Related Neoplasia Have Improved Outcomes With Decreasing Length's of Baseline Barrett's Eosophagus (BE) and Increasing Number of RFA Sessions

Haidry, Rehan; Butt, Mohammed A.; Gupta, Abhinav; Louis-Auguste, John; Dunn, Jason M.; Smart, Howard; Bhandari, Pradeep; Smith, Lesley Ann; Willert, Robert P.; Fullarton, Grant; Pietro, Massimiliano di; Gordon, Charles; Penman, Ian; Barr, Hugh; Patel, Praful; Boger, Philip; Kapoor, Neil; Mahon, Brinder S.; Hoare, Jonathan; Burnell, Matthew; Ravi, Narayanasamy; O’Toole, Dermot; Cheong, Edward; Direkze, Natalie; Ang, Yeng; Novelli, Marco; Banks, Matthew; Lovat, Laurence

doi:10.1016/j.gie.2013.04.045

Cited by 4 publications

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“…This may be due to the technical difficulty of completely treating a very long segment of BE, especially greater than 8 cm. Similarly, recent RFA studies have shown lower rates of eradication of dysplasia with ultra‐long segment disease . Our efficacy analysis included nine patients with BE longer than 8 cm, of whom three achieved CE‐IM and five achieved CE‐D.…”

Section: Discussionmentioning

confidence: 95%

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Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

Ghorbani

Tsai

Greenwald

et al. 2016

Diseases of the Esophagus

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Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high-grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low-grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open-label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2-3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE-D) and complete eradication of all intestinal metaplasia (CE-IM). Ninety-six subjects with Barrett's dysplasia (67% HGD; 65% long-segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow-up endoscopy (mean duration 21 months). In patients with LGD, rate of CE-D was 91% (21/23) and rate of CE-IM was 61% (14/23). In HGD, CE-D rate was 81% (46/57) and CE-IM was 65% (37/57). In patients with short-segment BE (SSBE) with any dysplasia, CE-D was achieved in 97% (30/31) and CE-IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non-steroidal anti-inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.

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Section: Discussionmentioning

confidence: 95%

“…Similarly, recent RFA studies have shown lower rates of eradication of dysplasia with ultra-long segment disease. 24 Our efficacy analysis included nine patients with BE longer than 8 cm, of whom three achieved CE-IM and five achieved CE-D.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

Ghorbani

Tsai

Greenwald

et al. 2016

Diseases of the Esophagus

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“…The following risk factors for recurrence were analyzed on multivariate logistic regression: nonwhite race (OR 1.67; 95 % CI, 1.01 -2.77), length of Barrett's segment (OR 1.09; 95 % CI, 1.04 -1.14), age (OR 1.02 per year; 95 % CI, 1.01 -1.03), number of RFA sessions (OR 0.85 per session; 95 % CI, 0.77 -0.94). Another large multicenter study on RFA in Barrett's-related neoplasia with similar results was presented by a UK group [14]. A total of 370 patients were analyzed.…”

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confidence: 79%

Esophageal disease

Pech

2013

Endoscopy

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DDW Highlights 729Eosinophilic esophagitis ! There are still various open questions regarding the natural course and treatment of eosinophilic esophagitis. A large retrospective analysis of 152 patients with eosinophilic esophagitis from a Swiss database investigated the influence of long-term treatment with topical corticosteroids on the natural course of the disease [1]. Clinical activity (defined as the presence of disease-related symptoms), endoscopic activity (whitish exudates, furrows, rings, strictures), biochemical activity (peripheral eosinophilia > 0.3 g/L), histological activity of eosinophilic esophagitis (presence of > 50 eosinophils per high-power field), and the presence of strictures (lumen < 12 mm) were recorded. During a median follow-up of 5 years (interquartile range [IQR] 2 -6 years), 152 patients had a total of 511 visits (mean 3.4 visits). Interestingly, patients showed clinical activity in 83 % of visits and were asymptomatic in 17 % of visits, only. In the multivariate logistic regression model, risk factors for clinical activity were active endoscopic (odds ratio [OR]: 4.01; 95 % confidence interval [CI], 2.15 -7.49), fibrotic (OR 4.37; 95 % CI, 2.42 -7.90), and the presence of histological activity (data not in abstract). Long-term use of topical steroids showed a significant negative association with clinical symptoms (OR 0.25; 95 % CI, 0.11 -0.54). This study demonstrated for the first time that long-term use of topical steroids could prevent symptoms. Unfortunately, the authors did not provide further information on how long treatment should be performed (eg, dose of corticosteroids, intermittent treatment). The fact that clinical activity showed a good correlation with endoscopic and histological activity, as also demonstrated in this series, seems obvious. The same group investigated the risk of stricture development and the duration of untreated eosinophilic esophagitis [2]. A total of 200 patients were retrospectively evaluated for the presence of strictures (defined as difficulty passing a normal diagnostic endoscope) at the first diagnosis of eosinophilic esophagitis and diagnostic delay of the disease (defined as time from onset of first symptoms to diagnosis). The median diagnostic delay in the study group was 6 years (IQR 2 -12 years). The authors were able to show that strictures developed over time in their patient cohort. When patients' disease duration was 0 to 2 years, the stricture prevalence was only 17.2 %. After 3 to 5 years, it was 30.8 %; 38.9 % after 6 to 8 years, 37.9 % after 9 to 11 years, 41.7 % after 12 to 14 years, 64.3 % after 15 to 17 years, and 66.7 % after 18 to 20 years. In patients with disease duration of longer than 20 years, more than 70 % of patients showed strictures at endoscopy. In the logistic regression analysis, the only risk factor for strictures at index endoscopy was a long duration of untreated disease, defined as a diagnostic delay of more than 7 years (OR 3.24; 95 % CI, 1.75 -5.97). A further large retrospective series from the Universi...

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Esophageal disease

Pech

2013

Gastrointestinal Endoscopy

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283 Patients Undergoing Radiofrequency Ablation (RFA) for Barrett's Related Neoplasia Have Improved Outcomes With Decreasing Length's of Baseline Barrett's Eosophagus (BE) and Increasing Number of RFA Sessions

Cited by 4 publications

References 0 publications

Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

Esophageal disease

Esophageal disease

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