SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2016/01  
 
  2016 Jan 6. pii: S0016-5107(16)00003-1  
  doi: 10.1016/j.gie.2015.12.034. [Epub ahead of print]  
 
  Single-session endoscopic resection and focal radiofrequency ablation for short-segment Barrett's esophagus with early neoplasia.  
 
  Barret M, Belghazi K, Weusten BL, Bergman JJ, Pouw RE  
  http://www.ncbi.nlm.nih.gov/pubmed/26769410  
 
 

BACKGROUND AND AIMS:

The management of early neoplasia in Barrett's esophagus (BE) requires endoscopic resection of visible lesions, followed by radiofrequency ablation (RFA) of the remaining BE. We evaluated the safety and efficacy of combining endoscopic resection and focal RFA in a single endoscopic session in patients with early BE neoplasia.

METHODS:

This was a retrospective analysis of patients with early BE neoplasia and a visible lesion undergoing combined endoscopic resection and focal RFA in a single session. Consecutive ablation procedures were performed every 8 to 12 weeks until complete endoscopic and histologic eradication of dysplasia and intestinal metaplasia were reached.

RESULTS:

Forty patients were enrolled, with a median C1M2 BE segment, a visible lesion with a median diameter of 15 mm, and invasive carcinoma in 68% of cases. Endoscopic resection was performed by using the multiband mucosectomy technique in 80% of cases, and the Barrx90 catheter (Barrx Medical, Sunnyvale, Calif) was used for focal ablation. When an intention-to-treat analysis was used, both complete remission of all neoplasia and intestinal metaplasia were 95% after a median follow-up of 19 months. Stenoses occurred in 33% of cases and were successfully managed with a median number of 2 dilations. In 43% of patients, 1 single-session treatment resulted in complete histologic remission of intestinal metaplasia.

CONCLUSIONS:

Combining endoscopic resection and focal RFA in a single session appears to be effective. Less-aggressive RFA regimens could limit the adverse event rates.

 
Question posée
 
Traitement de combiné de segment court d’œsophage de Barrett associant radiofréquence oesophagienne et résection au cours d’une même séance endoscopique.
 
Question posée
 
43% de rémission de métaplasie intestinale mais 33% de sténose symptomatique.
 
Commentaires

Même s’il parait très efficace, le traitement combiné en une seule séance d’un court segment d’œsophage de Barrett se complique d’un fort taux de sténose. Ce traitement ne semble pas la meilleure solution.

 
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