Combo treatment effective for early neoplastic Barrett's esophagus

Last Updated: 2015-03-31

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Endoscopic resection (ER) and radiofrequency ablation (RFA) benefit patients with early neoplastic Barrett's esophagus, according to new research from Europe.

In the largest prospective multicenter study to date on limited ER followed by RFA for early Barrett's neoplasia, the combination treatment was safe, effective and durable during medium-term follow-up, the study authors reported online March 2 in Gut.

This combined approach performed by trained endoscopists should be the treatment of first choice for carefully selected patients, they wrote.

"Our study confirms that in experts' hands we can not only effectively treat the neoplasia in Barrett's, but we can also eradicate the underlying premalignant condition," principal investigator Dr. Jacques Bergman of Academic Medical Center Amsterdam in the Netherlands told Reuters Health by email.

Dr. Bergman said patients with early Barrett's neoplasia should be treated only at high-volume centers.

At 13 centers in the EURO-II study, Dr. Bergman and colleagues treated 132 adults with Barrett's esophagus segment measuring 12 cm or less, with high-grade dysplasia and/or early cancer.

The maximum extent of ER was 2 cm in length and 50% of the circumference. This was followed by serial RFA every three months, for a maximum of five sessions. The patients underwent follow-up endoscopy at 6 months after the first negative post-treatment endoscopic control and annually thereafter.

After entry-ER in 119 patients (90%) and a median of three RFA treatments, in intention-to-treat analysis, 121 of 132 (92%) patients achieved complete eradication of neoplasia and 115 (87%) achieved complete eradication of intestinal metaplasia. In per-protocol analysis, 98% and 93% of patients, respectively, had complete eradication of neoplasia and intestinal metaplasia.

After a median of 27 months after the first negative post-treatment endoscopic control, neoplasia and intestinal metaplasia recurred in 4% and 8% of patients, respectively. Mild to moderate adverse events occurred in 25 patients (19%) and were all managed conservatively or endoscopically. Stricture (in 6% of patients) was the main adverse event and was resolved with dilation.

"We'd like to show that these results are maintained during longer follow-up. The five-year outcome data from our single center experience suggest that this is the case," Dr. Bergman said.

The EURO-II study was funded by GI Solutions, a subsidiary of Covidien, formerly BARRX Medical, which supported the work of seven authors.

SOURCES: http://bmj.co/1yx1twQ

Gut 2015.