Endoscopic resection with or without mucosal ablation of high grade dysplasia and early oesophageal adenocarcinoma – Long term follow up from a regional UK centre

Oliphant, Zoe; Snow, Alec; Knight, Hannah; Barr, Hugh; Almond, L. Max

doi:10.1016/j.ijsu.2014.09.002

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…Of these, 12 % (30/242) had received a rescue treatment (e. g. additional EMR, ESD, APC, or a combination of these) before CR-IM was achieved (▶ Table e2, available online-only). Treatment failed in 34 patients because of remaining IM (15), remaining dysplasia (11), need for surgery because of progression to adenocarcinoma (7) and there was one death due toe invasive adenocarcinoma. This was diagnosed on control biopsies after initial treatment with EMR and RFA (HALO 360) of long-segment Barrett's with previous histology of only HGD.…”

Section: Complete Remission Of Intestinal Metaplasiamentioning

confidence: 99%

Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Vliebergh

Deprez²,

Looze

et al. 2018

Endoscopy

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Background Radiofrequency ablation (RFA), combined with endoscopic resection, can be used as a primary treatment for low grade dysplasia, high grade dysplasia, and early esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE). The aim of the Belgian RFA registry is to capture the real-life outcome of endoscopic therapy for BE with RFA and to assess efficacy and safety outside study protocols, in the absence of reimbursement. Patients and methods Between February 2008 and January 2017, data from 7 different expert centers were prospectively collected in the registry. Efficacy outcomes included complete remission of intestinal metaplasia (CR-IM), complete remission of dysplasia (CR-D), and durability of remission. Safety outcomes included immediate and late adverse events. Results 684 RFA procedures in 342 different patients were registered. Of these, 295 patients were included in the efficacy analysis, with CR-IM achieved in 88 % and CR-D in 93 %, in per-protocol analysis; corresponding rates in intention-to-treat analysis were 82 % and 87 %, respectively. Sustained remission was seen in 65 % with a median (interquartile range) follow-up of 25 (12 – 47) months. No risk factors for recurrent disease were identified. Immediate complications occurred in 4 % of all procedures and 6 % of all patients, whereas late complications occurred in 9 % of all procedures and in 20 % of all patients. Conclusions Data from the Belgian registry confirm that RFA in combination with endoscopic resection is an efficient treatment for BE with dysplasia or early EAC. In the absence of reimbursement, more rescue treatments are used, not compromising outcome. Since there is recurrent disease after CR-IM in 35 %, surveillance endoscopy remains necessary.

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Section: Complete Remission Of Intestinal Metaplasiamentioning

confidence: 99%

Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Vliebergh

Deprez²,

Looze

et al. 2018

Endoscopy

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“…The management of intramucosal OAC is relatively consensual since several studies found a very low risk of LNM, ranging from 0 to 1.8%, and an improved overall survival rate in patients treated by endoscopic means compared to surgery. [18][19][20][21][22] Pech and colleagues, in one of the largest cohorts of intramucosal OAC treated endoscopically found a 96.3% complete remission rate and a 0.2% tumour-related death rate following ER for intramucosal OAC. 22 However, a significantly higher risk of recurrence and failure of endoscopic treatment was reported in poorly differentiated intramucosal OAC in contradiction to our data where the LNM risk was still non-existent for intramucosal OAC regardless of the histoprognostic features.…”

Section: Discussionmentioning

confidence: 99%

“…The management of intramucosal OAC is relatively consensual since several studies found a very low risk of LNM, ranging from 0% to 1.8%, and an improved overall survival rate in patients treated by endoscopic means compared to surgery 18–22 . Pech and colleagues, in one of the largest cohorts of intramucosal OAC treated endoscopically found a 96.3% complete remission rate and a 0.2% tumour‐related death rate following ER for intramucosal OAC 22 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases

et al. 2021

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Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma. Methods We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (≤1000 µm) and deep submucosal (>1000 µm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low-risk or a high-risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2-mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow-up from histological or PET CT reports when an invasive procedure was not possible. Results In total, 188 superficial oesophageal adenocarcinomas were included with a median follow-up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas ( n = 135) even with high-risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 µm developed lymph node metastasis tumours ( n = 10/53; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000-µm threshold for all low-risk tumours (0/25), nor under 1200 µm (0/1) and three over this threshold (3/13, 23.1%). Conclusion Intramucosal and low-risk tumours with shallow submucosal invasion up to 1200 µm were not associated with lymph node metastasis during follow-up. In case of high-risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.

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“…Used alone or with other minimally invasive methods, such as endoscopic mucosal resection, PDT has been shown to eliminate Barrett's mucosa, destroy the HGD, and potentially reduce the rate of progression to adenocarcinoma. [70][71][72] Cancer of the Esophagus Cancer of the esophagus affects over 450,000 individuals per year worldwide with 400,000 deaths. 73 Over 50% of cases are surgically unresectable at diagnosis, and 80% are oncologically at a stage for which surgery cannot be undertaken with curative intent.…”

Section: Barrett's Esophagus and Esophageal Cancermentioning

confidence: 99%

A Surgical View of Photodynamic Therapy in Oncology: A Review

Moghissi

Dixon

Gibbins

2015

Surg J

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Clinical photodynamic therapy (PDT) has existed for over 30 years, and its scientific basis has been known and investigated for well over 100 years. The scientific foundation of PDT is solid and its application to cancer treatment for many common neoplastic lesions has been the subject of a huge number of clinical trials and observational studies. Yet its acceptance by many clinicians has suffered from its absence from the undergraduate and/or postgraduate education curricula of surgeons, physicians, and oncologists. Surgeons in a variety of specialties many with years of experience who are familiar with PDT bear witness in many thousands of publications to its safety and efficacy as well as to the unique role that it can play in the treatment of cancer with its targeting precision, its lack of collateral damage to healthy structures surrounding the treated lesions, and its usage within minimal access therapy. PDT is closely related to the fluorescence phenomenon used in photodiagnosis. This review aspires both to inform and to present the clinical aspect of PDT as seen by a surgeon.

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Endoscopic resection with or without mucosal ablation of high grade dysplasia and early oesophageal adenocarcinoma – Long term follow up from a regional UK centre

Abstract: ER ± ablation is an effective and potentially curative option for patients with HGD or IMC. The benefit of endoscopic resection for disease staging was clearly demonstrated.

Cited by 6 publications

References 7 publications

Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases

A Surgical View of Photodynamic Therapy in Oncology: A Review

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