SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastroenterology
  2016/01  
 
  2015 Dec;149(7):1752-1761.e1  
  doi: 10.1053/j.gastro.2015.08.048. Epub 2015 Aug 29.  
 
  Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett's Esophagus  
 
  Wolf WA, Pasricha S, Cotton C, Li N, Triadafilopoulos G, Muthusamy VR, Chmielewski GW, Corbett FS, Camara DS, Lightdale CJ, Wolfsen H, Chang KJ, Overholt BF, Pruitt RE, Ertan A, Komanduri S, Infantolino A, Rothstein RI, Shaheen NJ  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=2015+Dec%3B149%287%29%3A1752-1761.e1.+doi%3A+10.1053%2Fj.gastro.2015.08.048.+Epub+2015+Aug+29.  
 
 

BACKGROUND & AIMS:

Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality.

METHODS:

We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality.

RESULTS:

Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA.

CONCLUSIONS:

Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

 
Question posée
 
Quel est le risque de développer un adénocarcinome malgré un traitement par radiofréquence (RF) pour EBO ?
 
Question posée
 
Les données de ce registre américain portant sur 4982 patients confirment l’existence d’un risque faible d’adénocarcinome après RF autour de 2%. L’existence initiale d’un long Barrett et d’une dysplasie de bas grade et de haut grade étaient des facteurs de risque associés à la survenue d’un cancer.
 
Commentaires

Ces données confirment l’efficacité de la radiofréquence, mais soulignent aussi la nécessité d’un suivi après traitement, ainsi que d’un excellent bilan endoscopique initial.

 
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