5-Aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett's oesophagus: a randomised trial

Hage, Maria Cristina Ferrarini Nunes Soares; Siersema, Peter D.; Dekken, H. van; Steyerberg, Ewout W.; Haringsma, Jelle; Vrie, Wim van de; Grool, T E; Veen, R.L.P. van; Sterenborg, Henricus J. C. M.; Kuipers, Ernst J.

doi:10.1136/gut.2003.028860

Cited by 132 publications

(121 citation statements)

References 34 publications

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“…Although this hypothesis cannot be confirmed, the 0.07% of subsquamous IM still compares favorably to the 53% rate of buried glands reported after other ablation techniques. [14][15][16][17][18][19][20][21] Our findings were in concordance with the absence of buried glands in 3,007 neosquamous biopsies after RF ablation in the 100 patients described by Sharma et al 25 Further studies on the adequacy of biopsies from the neosquamous epithelium after RFA should, however, clarify this issue further. Ablation at the GE-junction using the HALO 360 catheter may be difficult, since the often tortuous course of the distal esophagus and widening into a hiatal hernia, present in most BE patients, may impede good circumferential contact of the electrode with the mucosa at this level.…”

Section: Discussionsupporting

confidence: 78%

“…[10][11][12] Ablating the residual BE with argon plasma coagulation (APC) or photodynamic therapy (PDT) has also been described, but these techniques do not always result in complete eradication of all Barrett epithelium, preexisting oncogenetic alterations may still be found in residual areas of BE, and both techniques are associated with issues of variable ablation depth and safety. [14][15][16][17][18][19] Furthermore, after APC and PDT, areas of IM may become hidden underneath the newly formed squamous epithelium after ablation (a.k. a., "buried Barrett"), and some fear that these buried glands may progress to dysplasia and adenocarcinoma without being detected endoscopically.…”

Section: Introductionmentioning

confidence: 99%

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Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Pouw

Gondrie

Sondermeijer

et al. 2008

Journal of Gastrointestinal Surgery

113

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Background Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008. Methods Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloonbased catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated. Results Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n=16), high-grade dysplasia (n=12), low-grade dysplasia (n=3)]. Worst histology remaining after resection was high-grade (n=32), low-grade (n=10), or no (n=2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n=3) and transient dysphagia (n=4). After 21 months of follow-up (interquartile range 10-27), no dysplasia had recurred. Conclusions Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Pouw

Gondrie

Sondermeijer

et al. 2008

Journal of Gastrointestinal Surgery

113

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“…However, in a previous study, we found that in almost 80% of patients treated with ALA-PDT and/or APC, a complete histologic response was achieved 1 year after the first treatment. 17 Subsquamous islands of BE were more often found after APC (50%) than after ALA-PDT (4%). These data are supported by other studies describing buried glands in 6% of patients treated with ALA-PDT and 30% of patients treated with APC.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Most commonly used ablative therapies are argon plasma coagulation and photodynamic therapy. [8][9][10][11][12][13][14][15][16][17] However, success rates of these therapies vary and complete ablation is not achieved in all patients. Further, residual BE may be present after ablation in at least one-third of the patients and may be hidden underneath the restored squamous epithelial lining.…”

mentioning

confidence: 99%

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Hage

Siersema

Vissers

et al. 2005

Intl Journal of Cancer

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Barrett's esophagus (BE) is a major predisposing factor for the development of esophageal adenocarcinoma. Current strategies for treatment of BE, both dysplastic and nondysplastic, include photodynamic therapy (PDT) and argon plasma coagulation (APC). However, the effect of ablative therapy at the genetic level is unclear. We performed loss of heterozygosity (LOH) analysis of BE in baseline and follow-up biopsy specimens from 21 patients with BE (17 male, 4 female) treated with PDT and/or APC. At baseline, 14 patients had intestinal metaplasia without dysplasia (MET), 4 low-grade dysplasia (LGD) and 3 high-grade dysplasia (HGD). LOH was assessed using a panel of 9 polymorphic markers for evaluation of the P53 gene on 17p, P16 on 9p, DCC and SMAD4 on 18q and the APC gene on 5q. The tissue specimens obtained at baseline (t 5 0) were analysed, as well as the first (t 5 1; mean interval: 4 months) and last (t 5 2; mean interval: 8 months) available biopsy with residual or recurrent BE after ablation. At t 5 0, allelic loss was detected of 5q in 27%, 9p in 56%, 17p in 31% and 18q in 6% of informative cases. At t 5 1 (18 patients with persistent MET and 3 with LGD) and at t 5 2 (8 MET, 2 LGD), the LOH patterns were not statistically different from t 5 0. Further, multiple genetic lineages before and after therapy were detected in 15 cases illustrating the multiclonal nature of BE. We conclude that recurrent and/or persistent BE after ablative therapy still contains genetic alterations associated with malignant progression to cancer. Therefore, the goal of treatment should be the complete elimination of Barrett's mucosa. ' 2005 Wiley-Liss, Inc.

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“…It is very successful in eliminating high-grade dysplasia and early EAC in case series (48). It does have drawbacks of hypotension and even reported patient death (49). Radiofrequency ablation using a balloon based catheter system has been reported to be of value in elimination of Barrett's esophagus in 70% 12 months after initiation of treatment (50).…”

Section: The Management Of Dysplasiamentioning

confidence: 99%

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Sampliner

2008

The American Journal of Gastroenterology

1,280

893

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PREAMBLEThe guidelines for the diagnosis, surveillance and therapy of Barrett's esophagus were originally published by the American College of Gastroenterology in 1998 and updated in 2002. These and other guidelines undergo periodic review. Significant advances have occurred in the area of Barrett's esophagus over the past four years leading to another revision of the prior guidelines. These advances include the potential use of esophageal capsule endoscopy for the diagnosis and screening of Barrett's esophagus, data regarding the outcome of low-grade dysplasia, the treatment of high-grade dysplasia using photodynamic therapy, and the development of new ablation techniques such as radiofrequency ablation. These guidelines are intended to be applied by physicians who see Barrett's esophagus patients and are intended to indicate a preferred, but certainly not the only, acceptable approach. Physicians need to choose the course best suited to the individual patient and to the variables that exist at the time of decision making. The guidelines are for adult patients with the diagnosis of Barrett's esophagus, as defined herein.Both these and the original guidelines were developed under auspices of the American College of Gastroenterology and the Practice Parameters Committee and approved by the Board of Trustees. The world literature was reviewed extensively for the original guidelines and once again reviewed using the National Library of Medicine database. Search terms used included Barrett's esophagus, esophageal neoplasm, esophagus, intestinal metaplasia, esophageal diseases, and adenocarcinoma, all appropriate studies and any additional ones found in reference to these papers were obtained and reviewed. Evidence was available from a hierarchy of trials and randomized controlled trials were given the greatest weight. Abstracts presented at national and international meetings were only used when unique data from ongoing trials were presented. When scientific data were lacking, recommendations are based on expert opinion. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), Grade B indicates that the evidence would be level 2 or 3 which are cohort studies or case control studies. Grade C recommendations are based on level 4 studies meaning case series or poor quality cohort studies, and Grade D recommendations are based on level 5 evidence meaning expert opinion.

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5-Aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett's oesophagus: a randomised trial

Cited by 132 publications

References 34 publications

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

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