Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Long-term follow-up shows multipolar electrocoagulation ablation effective for Barrett's esophagus

26.04.2011
A new study reports that multipolar electrocoagulation in combination with acid suppression is a safe and effective method to ablate nondysplastic Barrett's esophagus over the long term. No adenocarcinoma (cancer) or high-grade dysplasia of the esophagus developed in any of the study patients.

This is the largest published series and longest follow-up of patients with nondysplastic Barrett's esophagus who underwent ablation therapy with multipolar electrocoagulation. The study appears in the April issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Barrett's esophagus is a condition where the lining of the esophagus changes because of chronic inflammation, generally due to gastroesophageal reflux disease (GERD). In the setting of chronic acid exposure, the cellular structure of the lower esophageal lining changes to look more like the cells lining the intestine. Barrett's esophagus itself has no specific symptoms, but this change can increase the risk of esophageal adenocarcinoma (a type of esophageal cancer). Barrett's esophagus can be readily detected during an upper endoscopy but must be confirmed by biopsies.

The usual approach is to properly diagnose Barrett's esophagus, use medical therapy to suppress acid, and follow the lining cells of the esophagus over time to detect changes before cancer has a chance to develop. If biopsies obtained during endoscopy detect dysplasia (a precancerous change in tissue), then a physician will recommend either close endoscopic surveillance (endoscopies at regular intervals with biopsies), endoscopic therapy or surgery. Endoscopic therapy may include removal of an area of Barrett's esophagus with dysplasia using endoscopic mucosal resection, which is a technique that allows removal of abnormal tissue in the esophagus without damaging the rest of the esophagus. Endoscopic ablation is a treatment which removes unwanted tissue and allows a healthy tissue lining to grow back. Endoscopic ablation of Barrett's tissue can be done using thermal based therapy such as radiofrequency ablation, multipolar electrocoagulation, or argon plasma coagulation. Another modality to destroy Barrett's cells is cryotherapy, which involves freezing of cells.

"Evolving technology has demonstrated the feasibility of reversing Barrett's esophagus by using a variety of ablative techniques combined with long-term acid suppression. These approaches have been best studied in patients with Barrett's esophagus who have low- or high-grade dysplasia and are therefore known to be at increased risk of progression to adenocarcinoma. A few reports have also described ablation in patients without dysplasia," said study lead author Harmony Allison, MD, Tufts Medical Center Division of Gastroenterology. "For more than 15 years, our group has offered ablation to patients with nondysplastic Barrett's esophagus who we followed prospectively. In patients that we followed for at least 10 years, we found that ablation of nondysplastic Barrett's esophagus with multipolar electrocoagulation ablation therapy in combination with acid suppression is a safe and effective method over the long term."

Methods

The prospective cohort study conducted at the Policlinica Metropolitana, a tertiary care clinic in Caracas, Venezuela, included 139 patients who had completed at least 10 years of follow-up for nondysplastic Barrett's esophagus and who had histologic evidence of intestinal metaplasia (abnormal tissue). The majority of the patients, (75 percent), were men and the mean age of the patients studied was 53 years. The study objective was to provide longer follow-up and determine the safety and efficacy of multipolar ablation for nondysplastic Barrett's esophagus using the outcome measurements of mortality, incidence of recurrent Barrett's esophagus, incidence of adenocarcinoma in ablated Barrett's esophagus, and morbidity associated with multipolar electrocoagulation. All patients were placed on high dose proton pump inhibitors (acid suppressors) twice daily starting one to two weeks before the ablation, during the entire treatment and for one year after completion of ablation therapy. After one year, patients were maintained on once daily proton pump inhibitors.

Patients underwent multipolar electrocoagulation ablation therapy to areas of Barrett's esophagus identified with magnification chromoendoscopy, which is performed by spraying specialized nonpermanent stains or dyes (in this case, acetic acid) on the inner lining of the esophagus to highlight the Barrett's tissue. After complete ablation, patients were followed on an annual basis with magnification chromoendoscopy. At annual visits, biopsy specimens were taken in areas identified at baseline as Barrett's esophagus. Targeted biopsy specimens were taken in areas of recurrent Barrett's esophagus identified by using magnification chromoendoscopy.

Results

Researchers concluded that long-term follow-up of ablation of Barrett's esophagus with multipolar electrocoagulation ablation therapy is a safe, effective method to ablate Barrett's esophagus over the long term. The number of sessions required to achieve complete Barrett's eradication ranged from one to five. Ninety-five percent of patients had no recurrence of Barrett's esophagus after initial ablation treatment was completed. Complications developed in less than five percent of patients, and all of the complications were minor. Recurrent Barrett's esophagus occurred in less than five percent of patients. No adenocarcinoma (cancer) or high-grade dysplasia of the esophagus developed in any of the patients. The researchers added that additional studies are needed to confirm their observations and ideally compare an ablative approach with standard surveillance.

In an accompanying editorial by Neil Gupta, MD, MPH, Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, University of Kansas Medical Center Kansas City, Kansas; Irving Waxman, MD, Department of Medicine, Section of Gastroenterology, Center for, Endoscopic Research and Therapeutics, University of Chicago Medical Center, Chicago, Illinois; and Prateek Sharma, MD, Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, University of Kansas Medical Center, Kansas City, Kansas, they state:

"Finally, as more endoscopic therapies become available, randomized, controlled trials will need to address which therapy (or combination of therapies) has the best effectiveness and safety profile in patients with HGD (high grade dysplasia) and EAC (early esophageal adenocarcinoma). Should we resect or burn? Burn or freeze? Or maybe we should do a combination of the three?"

About the American Society for Gastrointestinal Endoscopy

Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

About Endoscopy

Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.

Anne Brownsey | EurekAlert!
Further information:
http://www.asge.org

More articles from Health and Medicine:

nachricht Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine

nachricht Flexible sensors can detect movement in GI tract
11.10.2017 | Massachusetts Institute of Technology

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Ocean atmosphere rife with microbes

17.10.2017 | Life Sciences

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

17.10.2017 | Life Sciences

NASA finds newly formed tropical storm lan over open waters

17.10.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>