Skip to main content
Erschienen in: European Surgery 6/2015

01.12.2015 | Original Article

Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus

verfasst von: I. Kristo, S.F. Schoppmann, MD, M. Riegler, A. Püspök, K. Emmanuel, G. Spaun, F. Wrba, E. Wenzl, R. Schöfl, F. Schreiber, M. Häfner, C. Madl

Erschienen in: European Surgery | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Summary

Background

Barrett’s esophagus (BE) represents the premalignant manifestation of gastroesophageal reflux disease and includes columnar lined esophagus with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and cancer.

Methods

An Austrian panel of expert meeting was held at the Medical University Vienna, June 2015, to establish and define recommendations for the endoscopic treatment of BE with and without dysplasia and cancer. Recommendations are based on critical analysis of published evidence. Statistics were not applied.

Results

Diagnosis of cancer and dysplasia is to be reconfirmed by a second expert pathologist. Advanced cancer (> T1a) requires surgical resection ± adjuvant therapies. Treatment of T1a early cancer, high- and low-grade dysplasia should include endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). In the presence of increased cancer risk, BE without dysplasia should be treated by RFA within clinical studies only. Elimination of any early cancer, dysplasia and IM defines complete response, that is, post RFA histopathology shows squamous, cardiac or oxyntocardiac mucosa lined esophagus (Chandrasoma classification). Follow-up endoscopies are timed according to the base line histopathology. Down grade from cancer to dysplasia or from dysplasia to non-dysplastic BE defines partial response, respectively. Based on esophageal function testing, reflux is treated by medical or surgical therapy.

Conclusion

In Austria, RFA ± EMR is recommended for BE containing early cancer or dysplasia. Non-dysplastic BE with an increased cancer risk should be offered RFA within clinical trials to assess the efficacy for cancer prevention in this group of patients.
Literatur
1.
Zurück zum Zitat Lenglinger J, See SF, Beller L, Cosentini EP, Asari R, Wrba F, et al. Review on novel concepts of columnar lined esophagus. Wien Klin Wochenschr. 2013;125(19–20):577–90.CrossRefPubMed Lenglinger J, See SF, Beller L, Cosentini EP, Asari R, Wrba F, et al. Review on novel concepts of columnar lined esophagus. Wien Klin Wochenschr. 2013;125(19–20):577–90.CrossRefPubMed
2.
Zurück zum Zitat Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375–83.CrossRefPubMed Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375–83.CrossRefPubMed
3.
Zurück zum Zitat Lenglinger J, Riegler M, Cosentini E, Asari R, Mesteri I, Wrba F, et al. Review on the annual cancer risk of Barrett’s esophagus in persons with symptoms of gastroesophageal reflux disease. Anticancer Res. 2012;32(12):5465–73.PubMed Lenglinger J, Riegler M, Cosentini E, Asari R, Mesteri I, Wrba F, et al. Review on the annual cancer risk of Barrett’s esophagus in persons with symptoms of gastroesophageal reflux disease. Anticancer Res. 2012;32(12):5465–73.PubMed
4.
Zurück zum Zitat Arora GBS, Roorda AK, Triadafilopoulos G. Radiofrequency ablation of Barrett’s esophagus. Eur Surg. 2009;41(1):19–25.CrossRef Arora GBS, Roorda AK, Triadafilopoulos G. Radiofrequency ablation of Barrett’s esophagus. Eur Surg. 2009;41(1):19–25.CrossRef
5.
Zurück zum Zitat Lenglinger JIB, Eisler M, Wrba F, Zacherl J, Prager G, Riegler FM. Barrett’s esophagus: size of the problem and diagnostic value of a novel histopathology classification. Eur Surg. 2009;41(1):26–39.CrossRef Lenglinger JIB, Eisler M, Wrba F, Zacherl J, Prager G, Riegler FM. Barrett’s esophagus: size of the problem and diagnostic value of a novel histopathology classification. Eur Surg. 2009;41(1):26–39.CrossRef
6.
Zurück zum Zitat Rees JR, Lao-Sirieix P, Wong A, Fitzgerald RC, Treatment for Barrett’s oesophagus. Cochrane Database Syst Rev. 2010(1):CD004060. Rees JR, Lao-Sirieix P, Wong A, Fitzgerald RC, Treatment for Barrett’s oesophagus. Cochrane Database Syst Rev. 2010(1):CD004060.
8.
Zurück zum Zitat Statistik A. Austrian cancer and causes of death register. Version 17.10.2013, published online. Accessed July 2015. Statistik A. Austrian cancer and causes of death register. Version 17.10.2013, published online. Accessed July 2015.
9.
Zurück zum Zitat Duits LC, Phoa KN, Curvers WL, Ten Kate FJ, Meijer GA, Seldenrijk CA, et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut. 2015;64(5):700–6.CrossRefPubMed Duits LC, Phoa KN, Curvers WL, Ten Kate FJ, Meijer GA, Seldenrijk CA, et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut. 2015;64(5):700–6.CrossRefPubMed
10.
Zurück zum Zitat Phoa KN, Pouw RE, van Vilsteren FG, Sondermeijer CM, Ten Kate FJ, Visser M, et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology. 2013;145(1):96–104.CrossRefPubMed Phoa KN, Pouw RE, van Vilsteren FG, Sondermeijer CM, Ten Kate FJ, Visser M, et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology. 2013;145(1):96–104.CrossRefPubMed
11.
Zurück zum Zitat Riegler M, Asari R, Cosentini EP, Wrba F, Schoppmann SF. Critical assessment of a new endoscopic anatomic concept for the so-called cardia in the sense of the notions of Parmenides and Martin Heidegger. Z Gastroenterol. 2014;52(4):367–73.CrossRefPubMed Riegler M, Asari R, Cosentini EP, Wrba F, Schoppmann SF. Critical assessment of a new endoscopic anatomic concept for the so-called cardia in the sense of the notions of Parmenides and Martin Heidegger. Z Gastroenterol. 2014;52(4):367–73.CrossRefPubMed
12.
Zurück zum Zitat Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12):1209–17.CrossRefPubMed Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12):1209–17.CrossRefPubMed
13.
Zurück zum Zitat Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.CrossRefPubMed Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.CrossRefPubMed
14.
Zurück zum Zitat van Vilsteren FG, Alvarez Herrero L, Pouw RE, Schrijnders D, Sondermeijer CM, Bisschops R, et al. Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study. Endoscopy. 2013;45(7):516–25.CrossRefPubMed van Vilsteren FG, Alvarez Herrero L, Pouw RE, Schrijnders D, Sondermeijer CM, Bisschops R, et al. Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study. Endoscopy. 2013;45(7):516–25.CrossRefPubMed
15.
Zurück zum Zitat Kristo I, Asari R, Rieder E, Riegler V, Schoppmann SF. Treatment of Barrett’s esophagus: update on new endoscopic surgical modalities. Minerva Chir. 2015;70(2):107–18.PubMed Kristo I, Asari R, Rieder E, Riegler V, Schoppmann SF. Treatment of Barrett’s esophagus: update on new endoscopic surgical modalities. Minerva Chir. 2015;70(2):107–18.PubMed
16.
Zurück zum Zitat Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BL, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut. 2015 doi:10.1136/gutjnl-2015-309298. Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BL, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut. 2015 doi:10.​1136/​gutjnl-2015-309298.
17.
Zurück zum Zitat Lyday WD, Corbett FS, Kuperman DA, Kalvaria I, Mavrelis PG, Shughoury AB, et al. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy. 2010;42(4):272–8.CrossRefPubMed Lyday WD, Corbett FS, Kuperman DA, Kalvaria I, Mavrelis PG, Shughoury AB, et al. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy. 2010;42(4):272–8.CrossRefPubMed
18.
Zurück zum Zitat Sikkema M, Looman CW, Steyerberg EW, Kerkhof M, Kastelein F, van Dekken H, et al. Predictors for neoplastic progression in patients with Barrett’s Esophagus: a prospective cohort study. Am J Gastroenterol. 2011;106(7):1231–8.CrossRefPubMed Sikkema M, Looman CW, Steyerberg EW, Kerkhof M, Kastelein F, van Dekken H, et al. Predictors for neoplastic progression in patients with Barrett’s Esophagus: a prospective cohort study. Am J Gastroenterol. 2011;106(7):1231–8.CrossRefPubMed
19.
20.
Zurück zum Zitat Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA. 2013;310(6):627–36.CrossRefPubMed Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA. 2013;310(6):627–36.CrossRefPubMed
21.
Zurück zum Zitat El-Serag HB, Hashmi A, Garcia J, Richardson P, Alsarraj A, Fitzgerald S, et al. Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett’s oesophagus: a case-control study. Gut. 2014;63(2):220–9.PubMedCentralPubMed El-Serag HB, Hashmi A, Garcia J, Richardson P, Alsarraj A, Fitzgerald S, et al. Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett’s oesophagus: a case-control study. Gut. 2014;63(2):220–9.PubMedCentralPubMed
22.
Zurück zum Zitat Iftikhar SY, James PD, Steele RJ, Hardcastle JD, Atkinson M. Length of Barrett’s oesophagus: an important factor in the development of dysplasia and adenocarcinoma. Gut. 1992;33(9):1155–8.PubMedCentralCrossRefPubMed Iftikhar SY, James PD, Steele RJ, Hardcastle JD, Atkinson M. Length of Barrett’s oesophagus: an important factor in the development of dysplasia and adenocarcinoma. Gut. 1992;33(9):1155–8.PubMedCentralCrossRefPubMed
23.
Zurück zum Zitat Fleischer DE, Odze R, Overholt BF, Carroll J, Chang KJ, Das A, et al. The case for endoscopic treatment of non-dysplastic and low-grade dysplastic Barrett’s esophagus. Dig Dis Sci. 2010;55(7):1918–31.CrossRefPubMed Fleischer DE, Odze R, Overholt BF, Carroll J, Chang KJ, Das A, et al. The case for endoscopic treatment of non-dysplastic and low-grade dysplastic Barrett’s esophagus. Dig Dis Sci. 2010;55(7):1918–31.CrossRefPubMed
24.
Zurück zum Zitat Fleischer DE, Overholt BF, Sharma VK, Reymunde A, Kimmey MB, Chuttani R, et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy. 2010;42(10):781–9.CrossRefPubMed Fleischer DE, Overholt BF, Sharma VK, Reymunde A, Kimmey MB, Chuttani R, et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy. 2010;42(10):781–9.CrossRefPubMed
25.
Zurück zum Zitat Attwood SE, Ell C, Galmiche JP, Fiocca R, Hatlebakk JG, Hasselgren B, et al. Long-term safety of proton pump inhibitor therapy assessed under controlled, randomised clinical trial conditions: data from the SOPRAN and LOTUS studies. Aliment Pharmacol Ther. 2015;41(11):1162–74.CrossRefPubMed Attwood SE, Ell C, Galmiche JP, Fiocca R, Hatlebakk JG, Hasselgren B, et al. Long-term safety of proton pump inhibitor therapy assessed under controlled, randomised clinical trial conditions: data from the SOPRAN and LOTUS studies. Aliment Pharmacol Ther. 2015;41(11):1162–74.CrossRefPubMed
26.
Zurück zum Zitat Triadafilopoulos G. Proton pump inhibitors in Barrett’s esophagus: Pluripotent but controversial. Eur Surg. 2008;40(2):58–65.CrossRef Triadafilopoulos G. Proton pump inhibitors in Barrett’s esophagus: Pluripotent but controversial. Eur Surg. 2008;40(2):58–65.CrossRef
Metadaten
Titel
Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus
verfasst von
I. Kristo
S.F. Schoppmann, MD
M. Riegler
A. Püspök
K. Emmanuel
G. Spaun
F. Wrba
E. Wenzl
R. Schöfl
F. Schreiber
M. Häfner
C. Madl
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 6/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0362-4

Weitere Artikel der Ausgabe 6/2015

European Surgery 6/2015 Zur Ausgabe