Radiofrequency ablation for low-grade dysplasia in Barrett’s esophagus: long-term outcome of a randomized trial

Pouw, Roos E.; Klaver, Esther; Phoa, K. Nadine; Vilsteren, Frederike G. Van; Weusten, Bas L.; Bisschops, Raf; Schoon, Erik J.; Pech, Oliver; Manner, Hendrik; Ragunath, Krish; Fernández-Sordo, Jacobo Ortiz; Fullarton, Grant; Pietro, Massimiliano di; Januszewicz, Władysław; O’Toole, Dermot; Bergman, Jacques

doi:10.1016/j.gie.2020.03.3756

Cited by 58 publications

(43 citation statements)

References 17 publications

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“…The long‐term outcomes of a randomized control trial showed that RFA in LGD significantly reduces the risk of progression after a median follow up of 73 months. 21 Our study affirms the importance in offering endoscopic therapy to the T‐LGD cohort. They are a particularly higher‐risk cohort.…”

Section: Discussionsupporting

confidence: 76%

“…In our study, patients with LGD who had ablative therapy had a three times lower risk of progression relative to patients who were followed up with long‐term surveillance biopsies. The long‐term outcomes of a randomized control trial showed that RFA in LGD significantly reduces the risk of progression after a median follow up of 73 months 21 . Our study affirms the importance in offering endoscopic therapy to the T‐LGD cohort.…”

Section: Discussionsupporting

confidence: 69%

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The natural history of low‐grade dysplasia in Barrett's esophagus and risk factors for progression

et al. 2021

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Background and Aim Barrett's esophagus is associated with increased risk of esophageal adenocarcinoma. The optimal management of low‐grade dysplasia arising in Barrett's esophagus remains controversial. We performed a retrospective study from a tertiary referral center for Barrett's esophagus neoplasia, to estimate time to progression to high‐grade dysplasia/esophageal adenocarcinoma in patients with confirmed low‐grade dysplasia compared with those with downstaged low‐grade dysplasia from index presentation and referral. We analyzed risk factors for progression. Methods We analyzed consecutive patients with low‐grade dysplasia in Barrett's esophagus referred to a single tertiary center (July 2006–October 2018). Biopsies were reviewed by at least two expert pathologists. Results One hundred and forty‐seven patients referred with suspected low‐grade dysplasia were included. Forty‐two of 133 (32%) of all external referrals had confirmed low‐grade dysplasia after expert histopathology review. Multivariable analysis showed nodularity at index endoscopy (P < 0.05), location of dysplasia (P = 0.05), and endoscopic therapy after referral (P = 0.09) were associated with progression risk. At 5 years, 59% of patients with confirmed low‐grade dysplasia had not progressed versus 74% of patients in the cohort downstaged to non‐dysplastic Barrett's esophagus. Conclusion Our data show variability in the diagnosis of low‐grade dysplasia. The cumulative incidence of progression and time to progression varied across subgroups. Confirmed low‐grade dysplasia had a shorter progression time compared with the downstaged group. Nodularity at index endoscopy and multifocal low‐grade dysplasia were significant risk factors for progression. It is important to differentiate these high‐risk subgroups so that decisions on surveillance/endotherapy can be personalized.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 69%

The natural history of low‐grade dysplasia in Barrett's esophagus and risk factors for progression

et al. 2021

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“…This concept has been further explored to develop a probe for transurethral treatment of prostate cancer allowing full or focal gland ablation under MR-guidance [247]. The imaging [154,155,189,193,214] LI: Liver [50,70,82,83,101,145,146,159,163,193,196,[215][216][217][218][219] LU: Lung [87,88,99,114,138,144,157,169,190] PA: [86,93,95,137,158,185,[193][194][195] [150][151][152][153]191] Open circles represent explorative (small/few phase I/II) use and solid black circles represent many/large phase I/II trials, retrospective analyses or phase III evidence.…”

Section: Local Heating Techniquesmentioning

confidence: 99%

“…RFA and MWA are both widely used to ablate thoracic and gastrointenstinal tumors, e.g., liver [142,145,146,263], lung [142,[147][148][149], thyroid [150][151][152][153], kidney [154,155], breast [156], esophagus [144,157] and pancreas [158]. MWA is deemed capable of creating larger and more spherical ablation zones than RFA and thus clinical results of MWA are comparable to RFA for smaller lesions, but may be better for larger lesions [145,146].…”

Section: Local Heating Techniquesmentioning

confidence: 99%

Heating technology for malignant tumors: a review

Kok

Cressman

Ceelen

et al. 2020

International Journal of Hyperthermia

277

188

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The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.

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“…With confirmed LGD, the SURF study from 2014, in which 68 patients with LGD were randomized to either radiofrequency ablation (RFA) or surveillance, showed that active treatment reduced the progression to HGD or adenocarcinoma by 25% (p<0.001) [3]. Recently, a long-term follow-up study has been presented in which 96% of the patients treated with RFA experienced a sustained clearance after a median follow-up of 74 months [4]. RFA for confirmed LGD is now an integral part in most national [5] and international [6] guidelines.…”

Section: Introductionmentioning

confidence: 99%

Outcome after endoscopic treatment for dysplasia and superficial esophageal cancer – a cohort study

Hauge

Franco-Lie

Løberg

et al. 2020

Scandinavian Journal of Gastroenterology

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Background:Dysplasia and superficial esophageal cancer should initially be treated endoscopically. Little is known about post-procedural health-related quality of life (HRQL). The aim of this study was to present our results with endoscopic treatment and post-procedural HRQL. Material and methods:From June 2014 to December 2018 all patients treated with endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA) for low grade dysplasia (LGD), high grade dysplasia (HGD), T1a and a minority of patients with T1b at Oslo University Hospital were prospectively included. In June 2019 all patients alive were scored according to the Ogilvie dysphagia score as well as the QLQ-C30 and QLQ-OG25 for assessment of HRQL.Results: 86 patients were treated out of whom 22 (26%) had LGD, 44 (51%) HGD, 13 (15%) T1a and 6 patients (7%) T1b. Histology revealed adenocarcinoma in 18 (21%) and squamous cell carcinoma in one (1%), respectively. The mean follow-up was 22.9 months. Tumor regression or downstaging were archived in 78% of the patients with LGD, 66% of patients with HGD and in 89 % of patients with T1a/b. Five patients (6%) had esophagectomy. There were few and no serious complications. The 90-days mortality was 1%. 52 patients (88%) experienced no dysphagia (Ogilvie score 0). There was no difference in 11 out of the 15 variables in QLQ-C30 when compared to a non-cancerous reference population. Conclusion:Endoscopic treatment is safe and efficient for treatment of dysplasia and superficial esophageal cancer. The two-years post-procedural level of HRQL and dysphagia was satisfactory.

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Radiofrequency ablation for low-grade dysplasia in Barrett’s esophagus: long-term outcome of a randomized trial

Cited by 58 publications

References 17 publications

The natural history of low‐grade dysplasia in Barrett's esophagus and risk factors for progression

The natural history of low‐grade dysplasia in Barrett's esophagus and risk factors for progression

Heating technology for malignant tumors: a review

Outcome after endoscopic treatment for dysplasia and superficial esophageal cancer – a cohort study

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