Long-term outcomes of patients with Barrett's esophagus and high-grade dysplasia or early cancer treated with endoluminal therapies with intention to complete eradication

Background Endoluminal therapy is an option for selected patients with Barrett's esophagus and high-grade dysplasia or early cancer. Objective To assess long-term outcomes of patients treated with endoluminal therapy with the goal of complete eradication of all dysplasia and intestinal metaplas...

Full description

Saved in:
Bibliographic Details
Published in:Gastrointestinal endoscopy 2013-02, Vol.77 (2), p.190-199
Main Authors: Guarner-Argente, Carlos, MD, PhD, Buoncristiano, Thomas, Furth, Emma E., MD, Falk, Gary W., MD, MSc, Ginsberg, Gregory G., MD
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - therapy
Aged
Argon Plasma Coagulation
Barrett Esophagus - pathology
Barrett Esophagus - therapy
Catheter Ablation
Combined Modality Therapy
Esophageal Neoplasms - pathology
Esophageal Neoplasms - therapy
Esophagoscopy - methods
Female
Follow-Up Studies
Gastroenterology and Hepatology
Humans
Male
Middle Aged
Multivariate Analysis
Photochemotherapy
Proportional Hazards Models
Recurrence
Retrospective Studies
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Endoluminal therapy is an option for selected patients with Barrett's esophagus and high-grade dysplasia or early cancer. Objective To assess long-term outcomes of patients treated with endoluminal therapy with the goal of complete eradication of all dysplasia and intestinal metaplasia. Design Retrospective cohort study. Patients Selected patients referred with dysplastic Barrett's esophagus. Intervention Endoluminal therapy combining resection and photodynamic therapy, radiofrequency ablation, and/or argon plasma coagulation treatment was individualized based on patient and lesion characteristics, technique evolution, and interval response. Main Outcome Measurements We assessed complete eradication of dysplasia, all intestinal metaplasia, and recurrences. Results A total of 166 patients were treated and had at least 1 year of follow-up. Complete elimination of neoplasia was achieved in 157 patients (95%) and complete elimination of intestinal metaplasia in 137 patients (83%). After therapy, patients were followed for 33 (range 18-58) months. Among patients who achieved complete elimination of intestinal metaplasia, subsequent recurrent intestinal metaplasia was detected in 48 (35%) and dysplasia in 12 (9%). Among those who achieved only complete elimination of dysplasia, recurrent dysplasia was detected in 6 of 19 patients (32%). Multifocal dysplasia and patient's age were dysplasia and/or carcinoma recurrence risk factors in the multivariable and univariable analyses. Complete elimination of intestinal metaplasia was a protective factor in the univariable analysis. Retreatment achieved remission in 90% of cases. Forty-two patients (23.9%) had complications, including 21 with stricture (11.9%) and 1 treatment-related death. Limitations Retrospective study and evolution of endoscopic modalities. Conclusion Multiple-mode endoluminal therapy for Barrett's esophagus with high-grade dysplasia or early cancer with intention to complete eradication of all intestinal metaplasia was successful, with low observed recurrence of dysplasia or cancer. However, recurrence of intestinal metaplasia occurs in one-third of cases and supports continued endoscopic surveillance even after complete eradication.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2012.10.013