ASGE: Endoluminal Therapy May Treat Barrett's Esophagus

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OAK BROOK, Ill.―A new study from researchers at the Hospital of the University of Pennsylvania reports that endoluminal (endoscopic) therapies, combining resection and ablation techniques, for patients with Barrett’s esophagus and high-grade dysplasia or early mucosal cancer have a high success rate, with durable results and a low risk of complications.

The researchers noted that endoscopic surveillance after successful eradication is required. The study appears in the February issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Barrett’s esophagus (BE) is a precancerous condition with a known risk of progressing to cancer, especially when high-grade dysplasia (HGD, abnormal cells) is observed. Esophagectomy has been the standard treatment for BE with HGD or early mucosal cancer (intramucosal carcinoma). Endoluminal  therapy is an alternative to operative resection in selected patients with decreased morbidity and equivalent long-term results to surgery.

“Endoluminal therapy has not been broadly applied, and there is limited long-term follow-up.  Moreover, endoluminal therapy techniques have evolved over time, challenging assessments of long-term efficacy and effectiveness," said study lead author Gregory Ginsberg, MD, FASGE, Hospital of the University of Pennsylvania and past president of the American Society for Gastrointestinal Endoscopy.

“We sought to assess the efficacy, safety, and durability of an aggressive, endoscopic, multiple-mode approach of complete eradication of intestinal metaplasia (abnormal cells) in patients with HGD and/or intramucosal carcinoma," Ginsberg added. "We found that multiple-mode endoluminal therapy, combining resection and ablation techniques, for Barrett’s esophagus with high-grade dysplasia or early cancer with intention to complete eradication of all intestinal metaplasia was successful, with low observed recurrence of dysplasia or cancer. However, recurrence of intestinal metaplasia occurs in one-third of cases, therefore persistent vigilant surveillance is required."

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