TY - JOUR
T1 - Long-term outcomes after endoscopic treatment for Barrett's neoplasia with radiofrequency ablation +/- endoscopic resection
T2 - results from the national Dutch database in a 10-year period
AU - Dutch Barrett Expert Centers
AU - van Munster, Sanne
AU - Nieuwenhuis, Esther
AU - Weusten, Bas L A M
AU - Alvarez Herrero, Lorenza
AU - Bogte, Auke
AU - Alkhalaf, Alaa
AU - Schenk, B E
AU - Schoon, Erik J
AU - Curvers, Wouter
AU - Koch, Arjun D
AU - van de Ven, Steffi Elisabeth Maria
AU - de Jonge, Pieter Jan Floris
AU - Tang, Tjon J
AU - Nagengast, Wouter B
AU - Peters, Frans T M
AU - Westerhof, Jessie
AU - Houben, Martin H M G
AU - Bergman, Jacques Jghm
AU - Pouw, Roos E
AU - Kats-Ugurlu, Gürsah
AU - Karrenbeld, Arend
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/2
Y1 - 2022/2
N2 - OBJECTIVE: Radiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett's oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DESIGN: Endoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.RESULTS: After ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0-1; 1-2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22-69) and 4 endoscopies (1-5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.CONCLUSION: In a setting of centralised care, RFA±ER is effective for eradication of Barrett's related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.NETHERLANDS TRIAL REGISTER NUMBER: NL7039.
AB - OBJECTIVE: Radiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett's oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DESIGN: Endoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.RESULTS: After ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0-1; 1-2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22-69) and 4 endoscopies (1-5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.CONCLUSION: In a setting of centralised care, RFA±ER is effective for eradication of Barrett's related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.NETHERLANDS TRIAL REGISTER NUMBER: NL7039.
KW - Barrett's oesophagus
KW - Barrett's carcinoma
KW - endoscopic procedures
KW - LOW-GRADE DYSPLASIA
KW - BENCHMARK QUALITY CRITERIA
KW - INTESTINAL METAPLASIA
KW - ESOPHAGOGASTRIC JUNCTION
KW - MULTIBAND MUCOSECTOMY
KW - SYMPTOMATIC PATIENTS
KW - ESOPHAGUS
KW - PREVALENCE
KW - RISK
KW - THERAPY
U2 - 10.1136/gutjnl-2020-322615
DO - 10.1136/gutjnl-2020-322615
M3 - Article
C2 - 33753417
SN - 0017-5749
VL - 71
SP - 265
EP - 276
JO - Gut
JF - Gut
IS - 2
ER -