Comparison of endoscopic treatment modalities for Barrett’s neoplasia

Abstract

There are few data comparing endoscopic treatment outcomes for Barrett's esophagus (BE). To compare treatment outcomes in BE patients treated with radiofrequency ablation (RFA), RFA after EMR, and porfimer sodium photodynamic therapy (Ps-PDT). Retrospective, observational study. Single tertiary center between 2001 and2013. A total of 342 BE patients treated with RFA (n= 119), EMR+RFA (n= 98), and Ps-PDT (n= 125). Rates of complete remission of intestinal metaplasia (CRIM), BE recurrence, and adverse events. Baseline BE high-grade dysplasia (HGD) and adenocarcinoma were more common in the Ps-PDT group (89%) compared with the EMR-RFA (70%) and RFA (37%) groups. At a median follow-up of 14.2 months, 173 patients (50.6%) achieved CRIM. CRIM was significantly more common in Ps-PDT patients compared with RFA (P< .001) and EMR-RFA (P< .001) patients on multivariable analysis. In patients who achieved CRIM, the rates of subsequent BE recurrence were relatively similar among the 3 groups. Although the rates of bleeding were similar, strictures were less common in RFA patients (2.4%) compared with EMR-RFA (13.3%, P= .001) and Ps-PDT (10.4%, P=.043) patients. This study of endoscopic treatment for Barrett's dysplasia and neoplasia found that complete remission was achieved more often and more rapidly after Ps-PDT with similar disease recurrence rates compared with EMR or RFA. Adverse events were more common after EMR and Ps-PDT. Further studies are required to determine which ablation and resection techniques are ideally suited for each BE patient.