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Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
- Cancers autres (hors CCR et CHC)
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Originalité :
Très original
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| Doit faire évoluer notre pratique : |
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Immédiatement
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Nom du veilleur :
Docteur Michel GREFF
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Gut
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2015/08
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2015 Aug;64(8):1192-9
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doi: 10.1136/gutjnl-2014-308501
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Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry
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Haidry RJ, Butt MA, Dunn JM, Gupta A, Lipman G, Smart HL, Bhandari P, Smith L, Willert R, Fullarton G, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Kapoor N, Hoare J, Narayanasamy R, Ang Y, Veitch A, Ragunath K, Novelli M, Lovat LB; UK RFA Registry.
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http://www.ncbi.nlm.nih.gov/pubmed/25539672
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BACKGROUND:
Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.
METHODS:
We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated.
RESULTS:
508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).
CONCLUSIONS:
Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients.
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Quels sont les résultats à long terme de l’éradication de la muqueuse de Barrett et de la dysplasie en combinant mucosectomie et radiofréquence ?
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L’étude prospective met en évidence dans les deux périodes étudiées (2008-2010 / 2011-2013) à partir du registre Barrett du Royaume-Uni, une significative élévation du taux de réussite et de l’éradication du tissu métaplasique et de la dysplasie sans progression de l’incidence de l’adénocarcinome du cardia.
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L’originalité de l’article réside dans l’utilisation du registre de muqueuse de Barrett au Royaume-Uni.
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