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Thématique :
- Endoscopie/Imagerie
- Cancers autres (hors CCR et CHC)
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Pas encore
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Nom du veilleur :
Docteur Edouard Chabrun
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Gastroenterology
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2015/09
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2015 Sep;149(3):567-576.e3
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doi: 10.1053/j.gastro.2015.04.013
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Radiofrequency Ablation Is Associated With Decreased Neoplastic Progression in Patients With Barrett's Esophagus and Confirmed Low-Grade Dysplasia
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Small AJ, Araujo JL, Leggett CL, Mendelson AH, Agarwalla A, Abrams JA, Lightdale CJ, Wang TC, Iyer PG, Wang KK, Rustgi AK, Ginsberg GG, Forde KA, Gimotty PA, Lewis JD, Falk GW, Bewtra M
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http://www.ncbi.nlm.nih.gov/pubmed/25917785
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BACKGROUND & AIMS:
Barrett's esophagus (BE) with low-grade dysplasia (LGD) can progress to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) has been shown to be an effective treatment for LGD in clinical trials, but its effectiveness in clinical practice is unclear. We compared the rate of progression of LGD after RFA with endoscopic surveillance alone in routine clinical practice.
METHODS:
We performed a retrospective study of patients who either underwent RFA (n = 45) or surveillance endoscopy (n = 125) for LGD, confirmed by at least 1 expert pathologist, from October 1992 through December 2013 at 3 medical centers in the United States. Cox regression analysis was used to assess the association between progression and RFA.
RESULTS:
Data were collected over median follow-up periods of 889 days (interquartile range, 264-1623 days) after RFA and 848 days (interquartile range, 322-2355 days) after surveillance endoscopy (P = .32). The annual rates of progression to HGD or EAC were 6.6% in the surveillance group and 0.77% in the RFA group. The risk of progression to HGD or EAC was significantly lower among patients who underwent RFA than those who underwent surveillance (adjusted hazard ratio = 0.06; 95% confidence interval: 0.008-0.48).
CONCLUSIONS:
Among patients with BE and confirmed LGD, rates of progression to a combined end point of HGD and EAC were lower among those treated with RFA than among untreated patients. Although selection bias cannot be excluded, these findings provide additional evidence for the use of endoscopic ablation therapy for LGD.
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L’EBO en dysplasie de bas grade évolue-t-il de la même manière vers la dysplasie de haut grade ou l’adénocarcinome sans traitement qu’après ablation par radiofréquence (ARF) oesophagienne ?
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Avec un suivi inférieur à 3 ans, après ARF, le taux de progression annuelle vers la DHG ou adénocarcinome est de 0,77% contre 6,6% sans traitement.
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1-La durée de suivi de cette étude rétrospective est insuffisante pour évaluer l’évolution de l’EBO en DBG ver la DHG ou adénocarcinome.
2-Le taux de progression annuel de la DBG vers la DHG ou adénocarcinome de cette étude est bien supérieur à celui décrit dans la littérature (qui est plutôt de 1,7 à 2 %/patient/an).
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