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Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.

Publication ,  Journal Article
Ganz, RA; Overholt, BF; Sharma, VK; Fleischer, DE; Shaheen, NJ; Lightdale, CJ; Freeman, SR; Pruitt, RE; Urayama, SM; Gress, F; Pavey, DA ...
Published in: Gastrointest Endosc
July 2008

BACKGROUND: The management strategies for Barrett's esophagus (BE) that contains high-grade dysplasia (HGD) include intensive endoscopic surveillance, photodynamic therapy, thermal ablation, EMR, and esophagectomy. OBJECTIVE: To assess the safety and effectiveness of endoscopic circumferential balloon-based ablation by using radiofrequency energy for treating BE HGD. DESIGN: Multicenter U.S. registry. SETTING: Sixteen academic and community centers; treatment period from September 2004 to March 2007. PATIENTS: Patients with histologic evidence of intestinal metaplasia (IM) that contained HGD confirmed by at least 2 expert pathologists. A prior EMR was permitted, provided that residual HGD remained in the BE region for ablation. INTERVENTION: Endoscopic circumferential ablation with follow-up esophageal biopsies to assess the histologic response to treatment. OUTCOMES: Histologic complete response (CR) end points: (1) all biopsy specimen fragments obtained at the last biopsy session were negative for HGD (CR-HGD), (2) all biopsy specimens were negative for any dysplasia (CR-D), and (3) all biopsy specimens were negative for IM (CR-IM). RESULTS: A total of 142 patients (median age 66 years, interquartile range [IQR] 59-75 years) who had BE HGD (median length 6 cm, IQR 3-8 cm) underwent circumferential ablation (median 1 session, IQR 1-2). No serious adverse events were reported. There was 1 asymptomatic stricture and no buried glands. Ninety-two patients had at least 1 follow-up biopsy session (median follow-up 12 months, IQR 8-15 months). A CR-HGD was achieved in 90.2% of patients, CR-D in 80.4%, and CR-IM in 54.3%. LIMITATIONS: A nonrandomized study design, without a control arm, a lack of centralized pathology review, ablation and biopsy technique not standardized, and a relatively short-term follow-up. CONCLUSIONS: Endoscopic circumferential ablation is a promising modality for the treatment of BE that contains HGD. In this multicenter registry, the intervention safely achieved a CR for HGD in 90.2% of patients at a median of 12 months of follow-up.

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Published In

Gastrointest Endosc

DOI

EISSN

1097-6779

Publication Date

July 2008

Volume

68

Issue

1

Start / End Page

35 / 40

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Sensitivity and Specificity
  • Risk Assessment
  • Registries
  • Precancerous Conditions
  • Middle Aged
  • Male
  • Immunohistochemistry
  • Humans
 

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Ganz, R. A., Overholt, B. F., Sharma, V. K., Fleischer, D. E., Shaheen, N. J., Lightdale, C. J., … U.S. Multicenter Registry, . (2008). Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc, 68(1), 35–40. https://doi.org/10.1016/j.gie.2007.12.015
Ganz, Robert A., Bergein F. Overholt, Virender K. Sharma, David E. Fleischer, Nicholas J. Shaheen, Charles J. Lightdale, Stephen R. Freeman, et al. “Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.Gastrointest Endosc 68, no. 1 (July 2008): 35–40. https://doi.org/10.1016/j.gie.2007.12.015.
Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, et al. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008 Jul;68(1):35–40.
Ganz, Robert A., et al. “Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.Gastrointest Endosc, vol. 68, no. 1, July 2008, pp. 35–40. Pubmed, doi:10.1016/j.gie.2007.12.015.
Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, Freeman SR, Pruitt RE, Urayama SM, Gress F, Pavey DA, Branch MS, Savides TJ, Chang KJ, Muthusamy VR, Bohorfoush AG, Pace SC, DeMeester SR, Eysselein VE, Panjehpour M, Triadafilopoulos G, U.S. Multicenter Registry. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008 Jul;68(1):35–40.
Journal cover image

Published In

Gastrointest Endosc

DOI

EISSN

1097-6779

Publication Date

July 2008

Volume

68

Issue

1

Start / End Page

35 / 40

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Sensitivity and Specificity
  • Risk Assessment
  • Registries
  • Precancerous Conditions
  • Middle Aged
  • Male
  • Immunohistochemistry
  • Humans