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 Pruitt, Shiro M. 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 PanjehpourGeorge 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 1 2008

    Fingerprint

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

    All Science Journal Classification (ASJC) codes

    • Radiology Nuclear Medicine and imaging
    • 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; Urayama, Shiro M.; 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, 01.07.2008, p. 35-40.

    Research output: Contribution to journalArticle

    Ganz, RA, Overholt, BF, Sharma, VK, Fleischer, DE, Shaheen, NJ, Lightdale, CJ, Freeman, SR, Pruitt, R, 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 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 ; Urayama, Shiro M. ; 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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    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.",
    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 Ronald Pruitt and Urayama, {Shiro M.} 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

    AU - Urayama, Shiro M.

    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 - 2008/7/1

    Y1 - 2008/7/1

    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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