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Original article
Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)
  1. K Nadine Phoa1,
  2. Roos E Pouw1,
  3. Raf Bisschops2,
  4. Oliver Pech3,
  5. Krish Ragunath4,
  6. Bas L A M Weusten5,
  7. Brigitte Schumacher6,
  8. Bjorn Rembacken7,
  9. Alexander Meining8,
  10. Helmut Messmann9,
  11. Erik J Schoon10,
  12. Liebwin Gossner11,
  13. Jayan Mannath4,
  14. C A Seldenrijk12,
  15. Mike Visser13,
  16. Toni Lerut2,
  17. Stefan Seewald14,
  18. Fiebo J ten Kate13,
  19. Christian Ell3,
  20. Horst Neuhaus6,
  21. Jacques J G H M Bergman1
  1. 1Department of Gastroenterology and Hepatology, Academic Medical Centre—University of Amsterdam, Amsterdam, the Netherlands
  2. 2Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium
  3. 3Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
  4. 4Department of Gastroenterology, Queens Medical Centre, Nottingham, UK
  5. 5Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
  6. 6Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
  7. 7Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK
  8. 8Department of Gastroenterology, Klinikum rechts der Isar, Munich, Germany
  9. 9Department of Gastroenterology, Augsburg Hospital, Augsburg, Germany
  10. 10Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands
  11. 11Department of Internal Medicine II, Karlsruhe Hospital, Karlsruhe, Germany
  12. 12Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands
  13. 13Department of Pathology, Academic Medical Centre—University of Amsterdam, Amsterdam, the Netherlands
  14. 14Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Jacques J J G H M Bergman, Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; j.j.bergman{at}amc.uva.nl

Abstract

Objective Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.

Design In 13 European centres, patients with BO≤12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter. Outcomes: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.

Results 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3–4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.

Conclusions In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.

Trial registration number NTR 1211, http://www.trialregister.nl.

  • OESOPHAGEAL CANCER
  • BARRETT'S CARCINOMA
  • ENDOSCOPIC PROCEDURES

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