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Radiofrequency in Barrett

Prashanthi N Thota, Zubin Arora, John A Dumot, Gary Falk, Tanmayee Benjamin, John Goldblum, Sunguk Jang, Rocio Lopez, John J Vargo
BACKGROUND AND AIMS: Endoscopic ablation therapy has become the mainstay of treatment of Barrett's associated dysplasia and intramucosal cancer (IMC). The widely available techniques for ablation are radiofrequency ablation (RFA) and cryotherapy. Our aim was to compare eradication rates of metaplasia and dysplasia with both these modalities. PATIENTS AND METHODS: Retrospective review of prospectively collected database of patients who underwent endoscopic therapy for Barrett's dysplasia or IMC from 2006 to 2011 was performed...
March 9, 2018: Digestive Diseases and Sciences
Kavel Visrodia, Liam Zakko, Siddharth Singh, Cadman L Leggett, Prasad G Iyer, Kenneth K Wang
BACKGROUND AND AIMS: A small but significant proportion of patients with Barrett's esophagus (BE) have persistent dysplasia or intestinal metaplasia (IM) after treatment with radiofrequency ablation (RFA). Cryotherapy is a cold-based ablative modality that is increasingly being used in this setting. We aimed to better understand the efficacy of second-line cryotherapy in BE patients with persistent dysplasia or IM after RFA by conducting a systematic review and meta-analysis. METHODS: We performed a systematic literature search of PUBMED, EMBASE, and Web of Sciences through September 1, 2017...
February 21, 2018: Gastrointestinal Endoscopy
Sanjeev S Solomon, Shivangi Kothari, George B Smallfield, Sumant Inamdar, Peter Stein, Viviana A Rodriguez, Adam P Sima, Krystle Bittner, Alvin M Zfass, Vivek Kaul, Arvind J Trindade
GOALS AND BACKGROUND: Two common endoscopic therapies for eradication of dysplastic Barrett's esophagus are radiofrequency ablation (RFA) and liquid nitrogen spray cryotherapy (LNC). There is no data comparing postprocedural pain. This study aimed to compare the incidence of postprocedural pain between the 2 ablation modalities. METHODS: This is a multicenter prospective study in which pain intensity scores and the presence of dysphagia were assessed immediately before and after treatment, 48 hours posttreatment and at 3 weeks posttreatment using validated instruments...
January 18, 2018: Journal of Clinical Gastroenterology
M Riegler, I Kristo, M Nikolic, E Rieder, S F Schoppmann
Background: Barrett's esophagus (BE) is the premalignant manifestation of gastroesophageal reflux disease (GERD). Radiofrequency ablation (RFA) with and without endoscopic resection (ER) is a novel treatment for BE. Methods: Here we present a single-center update of the recommendations of a recent (June 2015) interdisciplinary expert panel meeting on the management of BE with dysplasia as well as cancer-positive and cancer-negative BE. We conducted a PubMed search of studies published in 2016 and 2017 on the topic of BE and RFA...
2017: European Surgery: ACA: Acta Chirurgica Austriaca
S Subramaniam, K Kandiah, F Chedgy, P Meredith, G Longcroft-Wheaton, P Bhandari
The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy...
December 2, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
José-Miguel Esteban, Pedro González-Carro, Joan B Gornals, Carlos Collados, María Álvarez, Alejandro Pérez-Mitru, Suzan Serip
BACKGROUND AND STUDY AIMS: To assess the cost-effectiveness of introducing endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection in selected patients into the standard of care of Barrett's esophagus with high-grade dysplasia or low-grade dysplasia in Spain. METHODS: The disease evolution was modeled via a semi-Markov model. The treatment strategies compared included endoscopic treatment based on radiofrequency ablation plus endoscopic mucosal resection and the Standard of Care (esophagectomy or palliative chemoradiotherapy according to disease status for high-grade dysplasia and endoscopic surveillance for low-grade dysplasia)...
November 23, 2017: Revista Española de Enfermedades Digestivas
Darina Kohoutova, Rehan Haidry, Matthew Banks, Mohammed Adil Butt, Jason Dunn, Sally Thorpe, Laurence Lovat
OBJECTIVE: Photodynamic therapy (PDT) was used as therapy for early neoplasia associated with Barrett's oesophagus (BE). This is 5-year follow-up of patients enrolled into randomised controlled trial of 5-aminolaevulinic acid (ALA) vs. Photofrin PDT. METHODS: Biopsies were taken from original Barrett's segment during endoscopic follow up using Seattle protocol. Endoscopic mucosal resection (EMR) ± radiofrequency ablation (RFA) was preferred therapy in patients who failed PDT and/or had recurrent neoplasia...
November 21, 2017: Scandinavian Journal of Gastroenterology
Juan A Muñoz-Largacha, Virginia R Litle
The prevalence of gastroesophageal reflux disease as well as the incidence of Barrett's esophagus (BE) has increased in the Western world over the last decades. The chronic reflux of gastric secretions injuries the esophageal mucosa and triggers cellular and molecular changes inducing the transformation of the normal squamous mucosa into columnar metaplastic epithelium. BE is a premalignant condition that can progress to low-grade dysplasia, high-grade dysplasia and ultimately esophageal adenocarcinoma. An early diagnosis of dysplastic changes and the adoption of appropriate therapeutic approaches are essential to improve patient outcomes and survival...
2017: Journal of Visualized Surgery
Javier Aranda-Hernández, Yuto Shimamura, Andrea Grin, Yugo Iwaya, Maria Cirocco, Gabor Kandel, Gary May, Paul Kortan, Spiro Raftopoulos, Norman Marcon
Background and study aim Both endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) are used to treat Barrett's esophagus (BE) complicated by dysplasia and intramucosal cancer. However, focal areas of BE can remain after otherwise successful application of these techniques. We report the results of hot avulsion using a hot biopsy forceps to resect these residual focal areas. Patients and methods This was a retrospective study from a prospective database in a tertiary reference center from August 2013 to May 2015...
October 24, 2017: Endoscopy
A Kahn, M Al-Qaisi, V T Kommineni, J K Callaway, E S Boroff, G E Burdick, D M Lam-Himlin, M Temkit, M F Vela, F C Ramirez
Radiofrequency ablation of Barrett's esophagus with low-grade dysplasia is recommended in recent American College of Gastroenterology guidelines, with endoscopic surveillance considered a reasonable alternative. Few studies have directly compared outcomes of radiofrequency ablation to surveillance and those that have are limited by short duration of follow-up. This study aims to compare the long-term effectiveness of radiofrequency ablation versus endoscopic surveillance in a large, longitudinal cohort of patients with Barrett's esophagus, and low-grade dysplasia...
September 27, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
(no author information available yet)
Patients with Barrett's esophagus (BE)/columnar lined esophagus (CLE) and adenocarcinoma are increasing, in whom 0.61% BE/CLE would develop to adenocarcinoma. The prognosis of esophageal cancer is related to the tumor stage at diagnosis. To standardize the screening, diagnosis and therapy of BE and adenocarcinoma in China, 31 digestive diseases and digestive endoscopy experts and digestive histologists drafted the consensus on the basis of clinical experience and references. The consensus defined BE as a complication of gastroesophageal reflux disease...
September 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
G Lipman, R J Haidry
Barrett's oesophagus (BO) is the only known precursor to oesophageal adenocarcinoma (OAC). Dysplasia and intramucosal cancer arising in BO can safely be treated with endoscopic eradication therapy (EET) due to the low risk of subsequent lymph node metastasis. Treatment at an early stage is paramount due to the ongoing poor prognosis and outcomes of patients with advanced OAC. The mainstay of treatment is endoscopic resection of visible lesions for accurate staging followed by ablation therapy to all remaining columnar-lined epithelium, most commonly with radiofrequency ablation...
April 2017: Frontline Gastroenterology
Nour Hamade, Prateek Sharma
PURPOSE OF REVIEW: In this review, we discuss different endoscopic techniques in the eradication of Barrett's esophagus (BE) as well as some controversies in the field of treatment. RECENT FINDINGS: Patients with T1a esophageal adenocarcinoma and BE of high-grade dysplasia should undergo endoscopic ablative therapy. The most studied technique to date is radiofrequency ablation. It can be combined with endoscopic mucosal resection in cases containing nodular and flat lesions...
August 17, 2017: Current Gastroenterology Reports
Yuto Shimamura, Yugo Iwaya, Kenichi Goda, Christopher W Teshima
The incidence of Barrett's esophagus (BE)-related neoplasia in Western countries has increased in the past several decades and, even in Eastern countries, it appears to be increasing. Endoscopic therapies are the first-line treatment for BE-related neoplasia; however, there is still no standardized treatment strategy. Most of the data have been published from Western countries where the ultimate goal of treatment is complete eradication of BE mucosa removing subtle synchronous lesions and preventing metachronous neoplasia...
August 17, 2017: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Arvind J Trindade, Douglas K Pleskow, Neil Sengupta, Shivangi Kothari, Sumant Inamdar, Joshua Berkowitz, Vivek Kaul
BACKGROUND AND AIM: Liquid nitrogen cryotherapy (LNC) allows increased depth of ablation compared with radiofrequency ablation in Barrett's esophagus (BE). Expert centers may use LNC over radiofrequency ablation to ablate Barrett's esophagus after endoscopic resection of intramucosal cancer (IMCA). The aim of our study was to (1) evaluate the safety and efficacy of LNC ablation in patients with BE and IMCA and (2) to evaluate the progression to invasive disease despite therapy. METHODS: This was a multicenter, retrospective study of consecutive patients with BE who received LNC following endoscopic mucosal resection (EMR) of IMCA...
February 2018: Journal of Gastroenterology and Hepatology
Anand Mohapatra, Aaron M Potretzke, John Weaver, Barrett G Anderson, Joel Vetter, Robert S Figenshau
Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior...
2017: Journal of Kidney Cancer and VHL
Marcia Irene Canto, Julian A Abrams, Hannah T Künzli, Bas Weusten, Yoshihiro Komatsu, Blair A Jobe, Charles J Lightdale
BACKGROUND AND AIMS: Early esophageal squamous cell neoplasia (ESCN) can be successfully treated by EMR, endoscopic submucosal dissection (ESD), or radiofrequency ablation. A new portable, battery-powered cryotherapy system using nitrous oxide (cryoballoon focal ablation system [CbFAS]) has been used for Barrett's esophagus. It consists of a small hand-held device containing liquid nitrous oxide, which converts to gas within a low-pressure-compliant through-the-scope balloon and freezes targeted mucosa in contact with the balloon...
July 16, 2017: Gastrointestinal Endoscopy
Cary C Cotton, W Asher Wolf, Bergein F Overholt, Nan Li, Charles J Lightdale, Herbert C Wolfsen, Sarina Pasricha, Kenneth K Wang, Nicholas J Shaheen
BACKGROUND & AIMS: The goal of treatment for Barrett's esophagus (BE) with dysplasia is complete eradication of intestinal metaplasia (CEIM). The long-term durability of CEIM has not been well characterized, so the frequency and duration of surveillance are unclear. We report results from a 5-year follow-up analysis of patients with BE and dysplasia treated by radiofrequency ablation (RFA) in the randomized controlled Ablation of Intestinal Metaplasia Containing Dysplasia (AIM) trial...
September 2017: Gastroenterology
Kavel Visrodia, Liam Zakko, Kenneth K Wang
In the last decade, radiofrequency ablation in combination with endoscopic mucosal resection has simplified and improved the treatment of Barrett's esophagus. These treatments not only reduced the progression of dysplastic Barrett's esophagus to esophageal adenocarcinoma but also decreased treatment-related complications. More recent data from larger series with extended follow-up periods are emerging to refine expectations in patients treated with radiofrequency ablation. Although most patients achieve eradication of neoplasia and intestinal metaplasia, in the long-term a substantial portion of patients develop recurrent disease...
July 2017: Gastrointestinal Endoscopy Clinics of North America
Larissa L Fujii-Lau, Birtukan Cinnor, Nicholas Shaheen, Srinivas Gaddam, Srinadh Komanduri, V Raman Muthusamy, Ananya Das, Robert Wilson, Violette C Simon, Vladimir Kushnir, Daniel Mullady, Steven A Edmundowicz, Dayna S Early, Sachin Wani
BACKGROUND:  Conflicting data exist with regard to recurrence rates of intestinal metaplasia (IM) and dysplasia after achieving complete eradication of intestinal metaplasia (CE-IM) in Barrett's esophagus (BE) patients. AIM:  (i) To determine the incidence of recurrent IM and dysplasia achieving CE-IM and (ii) to compare recurrence rates between treatment modalities [radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) vs stepwise complete EMR (SRER)]...
June 2017: Endoscopy International Open
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