Thématique :
- Endoscopie - Imagerie
Originalité :
Très original
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
  2018 Jan;50(1):8-13.  
  doi: 10.1055/s-0043-119986.  
  Hot avulsion may be effective as salvage treatment for focal Barrett's esophagus remaining after endoscopic therapy for dysplasia or early cancer: a preliminary study  
  Aranda-Hernández J, Shimamura Y, Grin A, Iwaya Y, Cirocco M, Kandel G, May G, Kortan P, Raftopoulos S, Marcon N  



 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.


 This was a retrospective study from a prospective database in a tertiary reference center from August 2013 to May 2015. All included patients had undergone hot avulsion for eradication of residual focal areas of BE that were ≤ 1 cm and not suspicious for dysplasia, following at least one previous endoscopic treatment for dysplasia or intramucosal cancer.


 35 patients harboring 124 residual areas of 1 - 7 mm were treated with hot avulsion. After a mean follow-up of 17.4 months, all patients achieved complete eradication of residual focal BE. One of the patients required a second hot avulsion treatment. Hot avulsion provided samples in all cases but limited the assessment of dysplasia (cautery artifact) in 20.2 % of them. The only complication was bleeding in two patients, which was easily stopped by soft coagulation.


 Hot avulsion appears to be effective and safe in removing focal BE ≤ 1 cm at its greatest length remaining after endoscopic treatment for dysplasia or early cancer. Further studies are required before this technique can be considered the standard of care.


Question posée
Que faire en cas de résidus de muqueuse de Barrett après radiofréquence (RF) ?
Question posée
Etude canadienne rétrospective monocentrique sur 35 patients ayant des résidus <1 cm après traitement par radiofréquence. Au total, 124 zones ont été traitées par exérèse à la pince chaude après injection sous-muqueuse. Une éradication complète de la muqueuse de Barrett était obtenue chez 100% des patients. Aucune perforation n'était notée.

Une technique simple et peu onéreuse pour traiter les petits résidus de Barrett après RF ? A à confirmer sur des séries prospectives de plus grand effectif…