EMR before radiofrequency ablation safe and effective for patients with nodular Barrett's esophagus

A new study shows that endoscopic mucosal resection (EMR) before radiofrequency ablation (RFA) is a safe and effective treatment option for patients with nodular Barrett's esophagus (BE) and advanced neoplasia. The performance of EMR before RFA was not associated with a diminished likelihood of success of therapy or an increased rate of stricture compared with those with advanced neoplasia undergoing RFA alone. The study appears in the October issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Barrett's esophagus is a precancerous condition associated with cancer of the esophagus, a condition with a marked increase in incidence over the past four decades. BE with high-grade dysplasia (HGD, abnormal cells) may progress to cancer in as many as 20 percent of patients per year. Similarly, BE with intramucosal carcinoma (IMC) is a high-risk lesion in the absence of disease altering therapy. Radiofrequency ablation is a safe and effective therapy for the eradication of nonnodular dysplastic BE. However, many patients with HGD or IMC have nodularity (a small mass of tissue in the form of a knot, swelling or protuberance, either normal or pathological) in their BE segment. EMR is commonly performed to remove these nodular areas before treatment with RFA. Although RFA and EMR are frequently performed, their safety and efficacy are poorly understood.

"The aims of this study were to compare the safety and efficacy of combined EMR/RFA treatment for nodular BE with that of treatment with RFA alone for nonnodular BE. We assessed whether preceding EMR leads to either a higher complication rate or decreased efficacy in comparison with patients requiring RFA alone," said study lead author Nicholas Shaheen, MD, MPH, University of North Carolina, Chapel Hill. "In patients treated with EMR before RFA for nodular BE with HGD or IMC, no differences in efficacy and safety outcomes were observed compared with RFA alone for nonnodular BE with HGD or IMC. EMR followed by RFA is safe and effective for patients with nodular BE and advanced neoplasia. To our knowledge, this study represents the largest published cohort of patients with BE and advanced neoplasia treated with EMR before RFA for nodular BE."

Source: American Society for Gastrointestinal Endoscopy

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