Publication details

Endoscopic Therapy versus Surveillance for Patients With Barrett Esophagus and Low-Grade dysplasia: prospective multicenter trial



Year of publication 2015
Type Conference abstract
Description Introduction: Barrett esophagus with low-grade dysplasia is associated with an increased risk of developing esophageal adenocarcinoma Aims & Methods: Prospective multicenter trial that enrolled 86 patients with a confirmed diagnosis of Barrett esophagus containing low-grade dysplasia at four Czech endoscopic sites since January 2012. Patient follow-up will end in December 2015. Eligible patients were assigned to either endoscopic treatment or endoscopic surveillance. Radiofrequency ablation was performed with the balloon device for circumferential ablation of the esophagus (BarrxTM360 RFA Balloon Catheter), or the focal device for targeted ablation (BarrxTM 90 and 60 RFA Focal Catheter). In case of visible lesion, endoscopic resection was performed with suck-and-cut technique. The primary outcome was comple teeradication of dysplasia during an 12 months follow-up with surveillance endoscopy in 6th and 12th month. Secondary outcomes were neoplastic progression to high-grade dysplasia or adenocarcinoma, complete eradication of intestinal metaplasia and adverse events. Results: Since January 2012 until March 2015, 49 individuals (43 men, mean age 54 years) received endoscopic therapy and 37 persons (22 men, mean age 61 years) received control. All patients used proton pump inhibitor (esomperazol 40mg daily) during the follow-up. The results at 6th month of follow-up are being presented. Among 25 patients in the therapy group who underwent surveillance endoscopy, complete eradication occurred in 100% for dysplasia and 60% for intestinal metaplasia. Among 27 patients in the control group, complete eradication occurred in 19% for dysplasia and 0% for intestinal metaplasia. One progression to high-grade dysplasia was recorded in the control group. Treatment-related adverse events occurred in 5 patients (10%) receiving endoscopic therapy (esophageal stricture, chest pain after procedure, overwedging of the ablation catheter and one perforation after dilatation of esophageal stricture) Conclusion: In this multicenter trial, endoscopic therapy of Barrett esophagus with low-grade dysplasia has appeared to have a high effectivity in eradication of dysplasia. Low incidence of neoplastic progression in control group can be explained by the short period of follow-up.

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