ENDOSCOPIC RADIOFREQUENCY ABLATION OR SURVEILLANCE OF BARRET’S ESOPHAGUS WITH LOW GRADE DYSPLASIA: A FRENCH MULTICENTER RANDOMIZED TRIAL

M Barret; F Prat; B Terris; T Ponchon; F Cholet; G Rahmi; E Coron; M Giovaninni; C Boustière; R Laugier; D Sautereau; F Zerbib; E Cesbron-Métivier; J Escourrou; G Vanbiervliet; J Branche; P Bauret; L Gilet; H Abdoul; S Leblanc; S Chaussade

doi:10.1055/s-0040-1704366

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(S 01): S118-S119
DOI: 10.1055/s-0040-1704366

ESGE Days 2020 oral presentations

Saturday, April 25, 2020 11:00 – 13:00 Finders keepers Liffey Hall 1

ENDOSCOPIC RADIOFREQUENCY ABLATION OR SURVEILLANCE OF BARRET’S ESOPHAGUS WITH LOW GRADE DYSPLASIA: A FRENCH MULTICENTER RANDOMIZED TRIAL

M Barret

¹Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France

,

F Prat

²Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastoenterology and Digestive Oncology, Paris, France

,

B Terris

³Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Pathology, Paris, France

,

T Ponchon

⁴Edouard Herriot Hospital, Gastroenterology, Lyon, France

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F Cholet

⁵Brest University Hospital, Gastroenterology, Brest, France

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G Rahmi

⁶Georges Pompidou European Hospital, Gastroenterology and Digestive Endoscopy, Paris, France

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E Coron

⁷Nantes University Hospital, Gastroenterology, Nantes, France

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M Giovaninni

⁸Paoli Calmettes Institute, Gastroenterology, Marseille, France

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C Boustière

⁹St Joseph Hospital, Gastroenterology, Marseille, France

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R Laugier

¹⁰La Timone Hospital, Gastroenterology, Marseille, France

,

D Sautereau

¹¹Limoges University Hospital, and University Limoges, Gastroenterology, Limoges, France

,

F Zerbib

¹²Bordeaux University Hospital, Gastroenterology, Bordeaux, France

,

E Cesbron-Métivier

¹³Angers University Hospital, Gastroenterology, Angers, France

,

J Escourrou

¹⁴Toulouse University Hospital, Gastroenterology, Toulouse, France

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G Vanbiervliet

¹⁵Nice University Hospital, Gastroenterology, Nice, France

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J Branche

¹⁶Lille University Hospital, Gastroenterology, Lille, France

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P Bauret

¹⁷Montpellier University Hospital, Gastroenterology, Montpellier, France

,

L Gilet

¹⁸Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Clinical Research Unit, Paris, France

,

H Abdoul

¹⁸Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Clinical Research Unit, Paris, France

,

S Leblanc

¹Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France

,

S Chaussade

¹Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France

› Institutsangaben

Abstract

Volltext

Aims Recent studies have suggested an annual neoplastic progression rate of Barrett’s esophagus (BE) containing low grade dysplasia (LGD) of 9 to 13%, leading to consider endoscopic ablation therapy rather than surveillance. We aimed to compare radiofrequency ablation (RFA) to endoscopic surveillance in the management of BE containing LGD.

Methods This is a prospective multicenter randomized study comparing RFA (up to 4 sessions every 2 months) to a yearly endoscopic surveillance. Inclusion criteria were the presence of a C >1 or M> 2 BE with intestinal metaplasia and LGD confirmed by an expert central pathologist. The main judgement criteria was the rate of LGD at 3 years, and the secondary judgement criteria were the rates of complete remission of intestinal metaplasia (CRIM), neoplastic progression at 3 years, and treatment morbidity.

Results 125 patients were included and 82 randomized, 40 in the RFA and 42 in the surveillance arm. The median (IQR) number of RFA sessions was 3 (2-4). In intention to treat, the 3-year prevalence of LGD was 34.3% [18.6-50.0] in the RFA group and 58.1% [40.7-75.4] in the surveillance group, OR = 0.38 [0.14-1.02], p= 0.05. The 3-year CRIM was 30% [15.8-44.2] vs. 0, p< 0.001 in the RFA and surveillance arms, respectively. The 3-year neoplastic progression rate was 13.5% in the RFA group and 27.5% in the surveillance group, p= 0.15. The complication rate was maximal after the first RFA treatment (16.9%) and diminished with the treatment sessions.

Conclusions A spontaneous regression of LGD on BE occurred in more than 40% of the patients in the surveillance group at three years. The 30% rate of CRIM, lower than reported in the literature, might explain the absence of significantly different 3-year neoplastic progression rates among the groups. Further analyses are needed to determine the factors associated with the CRIM failures.