Eradication Of High-grade Dysplasia Research Articles

OC-052 Combined EMR and Radio Frequency Ablation Leads to High Barrett’S Eradication Rates following Structured Training Programme

IntroductionEMR and Radio Frequency Ablation (RFA) have recently been combined to treat dysplastic Barrett’s oesophagus (1). These are complex techniques and require a high level of endoscopic skill and published...

Su1469 Efficacy of Radiofrequency Ablation in Management of Barrett's Esophagus: Real-Life Experience of Two Western Canadian Centers

Su1469 Efficacy of Radiofrequency Ablation in Management of Barrett's Esophagus: Real-Life Experience of Two Western Canadian Centers

Su1474 Safety and Efficacy of Endoscopic Spray Cryotherapy for Barrett's Dysplasia: Results of the National Cryospray Registry

Safety and Efficacy of Endoscopic Spray Cryotherapy for Barrett’s Dysplasia: Results of the National Cryospray Registry Shireen Ghorbani*, Franklin Tsai, Bruce D. Greenwald, Sunguk Jang, John A. Dumot, Matthew Mckinley, Nicholas J. Shaheen, Fadlallah Habr, Walter Coyle Division of Gastroenterology and Hepatology, Scripps Green Hospital, La Jolla, CA; Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD; Division of Gastroenterology, Cleveland Clinic, Cleveland, OH; Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH; Division of Gastroenterology, Prohealth Syosset Hospital, Lake Success, NY; Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC; Division of Gastroenterology, University Medicine Foundation, Providence, RI Background: Endoscopic spray cryotherapy has been shown to be efficacious in eradicating high-grade dysplasia (HGD) in Barrett esophagus (BE) in multiple retrospective series. However, large prospective series evaluating the safety and efficacy of cryotherapy for Barrett’s dysplasia, particularly low grade dysplasia (LGD), have been lacking. Methods: A multicenter, prospective open-label registry study including subjects with BE and HGD or LGD. Primary outcomes were complete eradication of dysplasia and complete eradication of all intestinal metaplasia. Results: One hundred thirty-four subjects (mean age 67 years, 86% male) with Barrett’s dysplasia (29% LGD, 71% HGD; 37% SSBE, 63% LSBE; mean length 4.2 cm) underwent 464 treatments (mean 3.5 sessions per subject). There were no esophageal perforations, reports of severe pain, or related deaths. Strictures developed in 3 subjects, 2 of which required dilation. One subject was hospitalized for post cryotherapy bleeding in the setting of NSAID use requiring endoscopic hemostasis clip placement. Thirty-four percent of subjects reported mild to moderate post procedure symptoms. For subjects with LGD (mean length 5 cm), 26 (67%) had completed all planned cryotherapy treatments (mean 2.6 sessions) and were included in the efficacy analysis. Twenty-three subjects (88%) had complete eradication of all dysplasia and 16 (62%) had complete eradication of all intestinal metaplasia. For subjects with HGD (mean length 3.9 cm), 82 (86%) had completed all planned cryotherapy treatments (mean 3.5 sessions) and were included in the efficacy analysis. Seventy-five subjects (91%) had complete eradication of HGD, 69 (84%) had complete eradication of all dysplasia and 56 (68%) had complete eradication of all intestinal metaplasia. Conclusions: In the largest prospective cohort to date, short-term data suggest that endoscopic spray cryotherapy is a safe and highly effective modality for eradication of Barrett’s with LGD or HGD.

Length of Barrett’s segment predicts success of extensive endomucosal resection for eradication of Barrett’s esophagus with early neoplasia

Although the efficacy and safety of extensive endomucosal resection (EMR) in eradicating Barrett's esophagus (BE) harbouring early neoplasia have been established, factors predicting efficacy remains unclear. To determine the complete eradication rate of Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or intramucosal carcinoma (IMC), safety, and factors predicting complete eradication by EMR. Patients with histological confirmation of Barrett's HGIN/IMC were prospectively identified. EMR was performed using Duette multiband ligator or cap technique by a single operator (NEM). 99 patients (81 males) with median age 67 years [interquartile range (IQR) 60-77 years] and median Barrett's length 4 cm (IQR 2-6 cm) were included. Of 628 index EMRs [mean 6.3, median 5 (IQR 3-8)], 23% showed IMC, 58.5% showed HGIN, and 16% showed low-grade dysplasia only. A median of 8 EMR resections per patient (IQR 6-16, 1,064 resections in 89 patients) resulted in complete eradication of BE harboring neoplasia in 49.4% and eradication of HGIN/IMC in 81% (BE <5 cm subgroup: 65% complete eradication and 91% HGIN eradication) at median follow-up of 18 months (range 6-27 months). On univariate analysis, focal dysplasia (P = 0.003) and Barrett's length <5 cm (P = 0.001) were predictors of complete BE eradication. Barrett's length <5 cm was the only significant predictor [odds ratio (OR) 3.4, standard error (SE) 0.11, P = 0.0006] on multiple logistic regression analysis. Strictures developed in 27% and major bleeding in 2% with no procedure-related perforations or mortality. Extensive EMR for removal of BE with early neoplasia is safe. Outcomes for complete BE eradication are modest at 49.4% and eradication of high-grade dysplasia at 81%. Barrett's length <5 cm is the only significant predictor of complete response.

Radio Frequency Ablation is More Effective in Shorter Segments of Barrett's Oesophagus for Eradication of High Grade Dysplasia/ Intramucosal Cancer – Results From the UK RFA HALO Registry

Radio Frequency Ablation is More Effective in Shorter Segments of Barrett's Oesophagus for Eradication of High Grade Dysplasia/ Intramucosal Cancer – Results From the UK RFA HALO Registry

Eradication of high-grade dysplasia using 5-ALA and acid suppression: A (photo)dynamic duo

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Eliminating adult T-cell leukaemia cells with ultrasound

1 Pass HI. Photodynamic therapy in oncology: mechanisms and clinical use. J Natl Cancer Inst 1993; 85: 443–56. 2 Barr H, Shepard NA, Dix A, Roberts DJH, et al. Eradication of highgrade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin. Lancet 1996; 348: 584–85. 3 Tachibana K, Kimura N, Okumura M, Eguchi H, Tachibana S. Enhancement of cell killing of HL-60 cells by ultrasound in the presence of photosensitizing drug: Photofrin II. Cancer Letters 1993; 72: 195–99. 4 Kessel D, Jeffers R, Fowlkes J, Cain C. Porphyrin-induced enhancement of ultrasound cytotoxicity. Int J Radiat Biol 1994; 66: 221–28. 5 Jeffers R, Feng R, Fowlkes J, Hunt J, Kessel D, Cain C. Dimethylformamide as an enhancer of cavitation-induced cell lysis in vitro. J Acoust Soc Am 1995; 97: 669–76.

Eradication of high-grade dysplasia in columnar-lined (Barrett's) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX

High-grade dysplasia in columnar-lined (Barrett's) oesophagus presents a difficult therapeutic dilemma. Choices for management are endoscopic surveillance to detect a cancer or oesophagectomy. One carries the risk of missing invasive cancer, the other carries worrying morbidity and mortality. We have used endoscopic photodynamic therapy to eradicate high-grade dysplasia. After the oral administration of 5-aminolaevulinic acid, the accumulation of the endogenously generated photosensitiser protoporphyrin IX was measured with quantitative fluorescence microscopy. Five patients with histologically confirmed high-grade dysplasia were treated with endoscopic photodynamic therapy with 630 nm laser light to activate the photosensitiser. Protoporphyrin IX accumulated in the dysplastic epithelium rather than the adjacent stroma. Selective necrosis of the dysplastic epithelium in columnar-lined oesophagus occurred after light activation. High-grade dysplasia was eradicated in all patients and squamous regeneration occurred after acid suppression with a protonpump inhibitor. There were no complications or recurrence of dysplasia after 26-44 months' endoscopic and histological follow-up. In two cases we saw non-dysplastic Barrett's epithelium underneath regenerative squamous mucosa. High-grade dysplasia in columnar-lined oesophagus can be eradicated by endoscopic photodynamic therapy with endogenously generated PpIX. Remaining non-dysplastic Barrett's epithelium will require surveillance, but overall the technique has interrupted or delayed the worsening of the dysplasia through to carcinoma. This technique may prevent the need for surgical excision in these patients.