Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia

a U.S. multicenter registry

Robert A. Ganz, Bergein F. Overholt, Virender K. Sharma, David E. Fleischer, Nicholas J. Shaheen, Charles J. Lightdale, Stephen R. Freeman, Ronald E. Pruitt, Shiro Urayama, Frank Gress, Darren A. Pavey, M. Stanley Branch, Thomas J. Savides, Kenneth J. Chang, V. Raman Muthusamy, Anthony G. Bohorfoush, Samuel C. Pace, Steven R. DeMeester, Viktor E. Eysselein, Masoud Panjehpour & 1 others George Triadafilopoulos

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalGastrointestinal Endoscopy
Volume68
Issue number1
DOIs
StatePublished - Jul 2008
Externally publishedYes

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Barrett Esophagus
Registries
Biopsy
Metaplasia
Ablation Techniques
Esophagectomy
Photochemotherapy
Pathologic Constriction
Therapeutics
Hot Temperature
Pathology
Safety

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Ganz, R. A., Overholt, B. F., Sharma, V. K., Fleischer, D. E., Shaheen, N. J., Lightdale, C. J., ... Triadafilopoulos, G. (2008). Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. multicenter registry. Gastrointestinal Endoscopy, 68(1), 35-40. https://doi.org/10.1016/j.gie.2007.12.015

Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia : a U.S. multicenter registry. / Ganz, Robert A.; Overholt, Bergein F.; Sharma, Virender K.; Fleischer, David E.; Shaheen, Nicholas J.; Lightdale, Charles J.; Freeman, Stephen R.; Pruitt, Ronald E.; Urayama, Shiro; Gress, Frank; Pavey, Darren A.; Branch, M. Stanley; Savides, Thomas J.; Chang, Kenneth J.; Muthusamy, V. Raman; Bohorfoush, Anthony G.; Pace, Samuel C.; DeMeester, Steven R.; Eysselein, Viktor E.; Panjehpour, Masoud; Triadafilopoulos, George.

In: Gastrointestinal Endoscopy, Vol. 68, No. 1, 07.2008, p. 35-40.

Research output: Contribution to journalArticle

Ganz, RA, Overholt, BF, Sharma, VK, Fleischer, DE, Shaheen, NJ, Lightdale, CJ, Freeman, SR, Pruitt, RE, Urayama, S, Gress, F, Pavey, DA, Branch, MS, Savides, TJ, Chang, KJ, Muthusamy, VR, Bohorfoush, AG, Pace, SC, DeMeester, SR, Eysselein, VE, Panjehpour, M & Triadafilopoulos, G 2008, 'Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. multicenter registry', Gastrointestinal Endoscopy, vol. 68, no. 1, pp. 35-40. https://doi.org/10.1016/j.gie.2007.12.015
Ganz, Robert A. ; Overholt, Bergein F. ; Sharma, Virender K. ; Fleischer, David E. ; Shaheen, Nicholas J. ; Lightdale, Charles J. ; Freeman, Stephen R. ; Pruitt, Ronald E. ; Urayama, Shiro ; Gress, Frank ; Pavey, Darren A. ; Branch, M. Stanley ; Savides, Thomas J. ; Chang, Kenneth J. ; Muthusamy, V. Raman ; Bohorfoush, Anthony G. ; Pace, Samuel C. ; DeMeester, Steven R. ; Eysselein, Viktor E. ; Panjehpour, Masoud ; Triadafilopoulos, George. / Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia : a U.S. multicenter registry. In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 1. pp. 35-40.
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author = "Ganz, {Robert A.} and Overholt, {Bergein F.} and Sharma, {Virender K.} and Fleischer, {David E.} and Shaheen, {Nicholas J.} and Lightdale, {Charles J.} and Freeman, {Stephen R.} and Pruitt, {Ronald E.} and Shiro Urayama and Frank Gress and Pavey, {Darren A.} and Branch, {M. Stanley} and Savides, {Thomas J.} and Chang, {Kenneth J.} and Muthusamy, {V. Raman} and Bohorfoush, {Anthony G.} and Pace, {Samuel C.} and DeMeester, {Steven R.} and Eysselein, {Viktor E.} and Masoud Panjehpour and George Triadafilopoulos",
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T1 - Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia

T2 - a U.S. multicenter registry

AU - Ganz, Robert A.

AU - Overholt, Bergein F.

AU - Sharma, Virender K.

AU - Fleischer, David E.

AU - Shaheen, Nicholas J.

AU - Lightdale, Charles J.

AU - Freeman, Stephen R.

AU - Pruitt, Ronald E.

AU - Urayama, Shiro

AU - Gress, Frank

AU - Pavey, Darren A.

AU - Branch, M. Stanley

AU - Savides, Thomas J.

AU - Chang, Kenneth J.

AU - Muthusamy, V. Raman

AU - Bohorfoush, Anthony G.

AU - Pace, Samuel C.

AU - DeMeester, Steven R.

AU - Eysselein, Viktor E.

AU - Panjehpour, Masoud

AU - Triadafilopoulos, George

PY - 2008/7

Y1 - 2008/7

N2 - 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.

AB - 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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