Long-term outcomes after endoscopic treatment for Barrett's neoplasia with radiofrequency ablation +/- endoscopic resection:results from the national Dutch database in a 10-year period

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 wit... Mehr ...

Verfasser: van Munster, Sanne
Nieuwenhuis, Esther
Weusten, Bas L A M
Alvarez Herrero, Lorenza
Bogte, Auke
Alkhalaf, Alaa
Schenk, B E
Schoon, Erik J
Curvers, Wouter
Koch, Arjun D
van de Ven, Steffi Elisabeth Maria
de Jonge, Pieter Jan Floris
Tang, Tjon J
Nagengast, Wouter B
Peters, Frans T M
Westerhof, Jessie
Houben, Martin H M G
Bergman, Jacques Jghm
Pouw, Roos E
Dokumenttyp: Artikel
Erscheinungsdatum: 2022
Reihe/Periodikum: Dutch Barrett Expert Centers , van Munster , S , Nieuwenhuis , E , Weusten , B L A M , Alvarez Herrero , L , Bogte , A , Alkhalaf , A , Schenk , B E , Schoon , E J , Curvers , W , Koch , A D , van de Ven , S E M , de Jonge , P J F , Tang , T J , Nagengast , W B , Peters , F T M , Westerhof , J , Houben , M H M G , Bergman , J J & Pouw , R E 2022 , ' Long-term outcomes after endoscopic treatment for Barrett's neoplasia with radiofrequency ablation +/- endoscopic resection : results from the national Dutch database in a 10-year period ' , Gut , vol. 71 , no. 2 , pp. 265-276 . https://doi.org/10.1136/gutjnl-2020-322615
Schlagwörter: Barrett's oesophagus / Barrett's carcinoma / endoscopic procedures / LOW-GRADE DYSPLASIA / BENCHMARK QUALITY CRITERIA / INTESTINAL METAPLASIA / ESOPHAGOGASTRIC JUNCTION / MULTIBAND MUCOSECTOMY / SYMPTOMATIC PATIENTS / ESOPHAGUS / PREVALENCE / RISK / THERAPY
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-29027967
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : https://hdl.handle.net/11370/67443fb8-c22b-4a5e-8563-80c5092f5f91

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 ...