Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial
ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another...
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| Veröffentlicht in: | Gut 2021-06, Vol.70 (6), p.1014-1022 |
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| creator | Barret, Maximilien Pioche, Mathieu Terris, Benoit Ponchon, Thierry Cholet, Franck Zerbib, Frank Chabrun, Edouard Le Rhun, Marc Coron, Emmanuel Giovannini, Marc Caillol, Fabrice Laugier, René Jacques, Jeremie Legros, Romain Boustiere, Christian Rahmi, Gabriel Metivier-Cesbron, Elodie Vanbiervliet, Geoffroy Bauret, Paul Escourrou, Jean Branche, Julien Jilet, Lea Abdoul, Hendy Kaddour, Nadira Leblanc, Sarah Bensoussan, Michael Prat, Frederic Chaussade, Stanislas |
| description | ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design.DesignA prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity.Results125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p |
| doi_str_mv | 10.1136/gutjnl-2020-322082 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04470392v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2523036349</sourcerecordid><originalsourceid>FETCH-LOGICAL-b442t-303700d17d1b3671cb98f30b64776f10a9282a866421d8575fef2ac2112747a43</originalsourceid><addsrcrecordid>eNqNkc1u1DAUhSMEokPhBVggS2xgkeK_-IddqQpFGokNrC3HcWY8cuJgO61mx2uw6Mv1SfAowyCxQKws-3733ON7quolghcIEfZuM-fd6GsMMawJxlDgR9UKUSbKTYjH1QpCxOuGU3lWPUtpByEUQqKn1RkhTDSSyVV1fz12IZkwOQOi7lzoo_0-29HsgW69zi6MIESQ5nhrnfd6NBa4EUylYsecwJ3LW_BBx2hzfvjxM4FgU5i2ejMfayaMvYuD7YAPd_WmzLCg26fJ6-T0e6DBMPvsTBGLtjgobgaXCp2j0_559aTXPtkXx_O8-vbx-uvVTb3-8unz1eW6binFuSaQcAg7xDvUEsaRaaXoCWwZ5Zz1CGqJBdaCMYpRJxre9LbH2mCEMKdcU3JevV10t9qrKbpBx70K2qmby7U6vEFKOSQS36LCvlnYKYayqZRVMWzsYTc2zElhKiWRhCBW0Nd_obswx7H8ROEGF9eMUFkovFAmhpSi7U8OEFSHoNUStDoErZagS9Oro_TcluWeWn4nW4B6Adph93-CF3_4k81_NPwCmUDE3A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2523036349</pqid></control><display><type>article</type><title>Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial</title><source>MEDLINE</source><source>PubMed Central</source><creator>Barret, Maximilien ; Pioche, Mathieu ; Terris, Benoit ; Ponchon, Thierry ; Cholet, Franck ; Zerbib, Frank ; Chabrun, Edouard ; Le Rhun, Marc ; Coron, Emmanuel ; Giovannini, Marc ; Caillol, Fabrice ; Laugier, René ; Jacques, Jeremie ; Legros, Romain ; Boustiere, Christian ; Rahmi, Gabriel ; Metivier-Cesbron, Elodie ; Vanbiervliet, Geoffroy ; Bauret, Paul ; Escourrou, Jean ; Branche, Julien ; Jilet, Lea ; Abdoul, Hendy ; Kaddour, Nadira ; Leblanc, Sarah ; Bensoussan, Michael ; Prat, Frederic ; Chaussade, Stanislas</creator><creatorcontrib>Barret, Maximilien ; Pioche, Mathieu ; Terris, Benoit ; Ponchon, Thierry ; Cholet, Franck ; Zerbib, Frank ; Chabrun, Edouard ; Le Rhun, Marc ; Coron, Emmanuel ; Giovannini, Marc ; Caillol, Fabrice ; Laugier, René ; Jacques, Jeremie ; Legros, Romain ; Boustiere, Christian ; Rahmi, Gabriel ; Metivier-Cesbron, Elodie ; Vanbiervliet, Geoffroy ; Bauret, Paul ; Escourrou, Jean ; Branche, Julien ; Jilet, Lea ; Abdoul, Hendy ; Kaddour, Nadira ; Leblanc, Sarah ; Bensoussan, Michael ; Prat, Frederic ; Chaussade, Stanislas</creatorcontrib><description>ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design.DesignA prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity.Results125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p<0.001). At the same time, the prevalence LGD was 34.3% (95% CI 18.6 to 50.0) in the RFA group vs 58.1% (95% CI 40.7 to 75.4) in the surveillance group (OR=0.38 (95% CI 0.14 to 1.02), p=0.05). Neoplastic progression was found in 12.5% (RFA) vs 26.2% (surveillance; p=0.15). The complication rate was maximal after the first RFA treatment (16.9%).ConclusionRFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD.Trial registration number NCT01360541.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gutjnl-2020-322082</identifier><identifier>PMID: 33685969</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Ablation ; Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - pathology ; Aged ; Anesthesia ; Barrett Esophagus - diagnostic imaging ; Barrett Esophagus - pathology ; Barrett Esophagus - therapy ; Barrett's oesophagus ; Biopsy ; Catheters ; Disease Progression ; Dysplasia ; endoscopic procedures ; Endoscopy ; Endoscopy, Gastrointestinal ; Eradication ; Esophageal cancer ; Esophageal Neoplasms - diagnostic imaging ; Esophageal Neoplasms - pathology ; Esophagus ; Female ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Intestine ; Life Sciences ; Male ; Metaplasia ; Middle Aged ; Morbidity ; oesophageal cancer ; Oesophagus ; Pathology ; Patients ; Prospective Studies ; Radiofrequency ablation ; Radiofrequency Ablation - adverse effects ; Surveillance ; Time Factors ; Treatment Outcome ; Watchful Waiting</subject><ispartof>Gut, 2021-06, Vol.70 (6), p.1014-1022</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b442t-303700d17d1b3671cb98f30b64776f10a9282a866421d8575fef2ac2112747a43</citedby><cites>FETCH-LOGICAL-b442t-303700d17d1b3671cb98f30b64776f10a9282a866421d8575fef2ac2112747a43</cites><orcidid>0000-0002-0566-7870 ; 0000-0002-6482-2375 ; 0000-0002-9452-1450 ; 0000-0002-6802-2121 ; 0000-0003-2251-9076</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33685969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04470392$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Barret, Maximilien</creatorcontrib><creatorcontrib>Pioche, Mathieu</creatorcontrib><creatorcontrib>Terris, Benoit</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Cholet, Franck</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Chabrun, Edouard</creatorcontrib><creatorcontrib>Le Rhun, Marc</creatorcontrib><creatorcontrib>Coron, Emmanuel</creatorcontrib><creatorcontrib>Giovannini, Marc</creatorcontrib><creatorcontrib>Caillol, Fabrice</creatorcontrib><creatorcontrib>Laugier, René</creatorcontrib><creatorcontrib>Jacques, Jeremie</creatorcontrib><creatorcontrib>Legros, Romain</creatorcontrib><creatorcontrib>Boustiere, Christian</creatorcontrib><creatorcontrib>Rahmi, Gabriel</creatorcontrib><creatorcontrib>Metivier-Cesbron, Elodie</creatorcontrib><creatorcontrib>Vanbiervliet, Geoffroy</creatorcontrib><creatorcontrib>Bauret, Paul</creatorcontrib><creatorcontrib>Escourrou, Jean</creatorcontrib><creatorcontrib>Branche, Julien</creatorcontrib><creatorcontrib>Jilet, Lea</creatorcontrib><creatorcontrib>Abdoul, Hendy</creatorcontrib><creatorcontrib>Kaddour, Nadira</creatorcontrib><creatorcontrib>Leblanc, Sarah</creatorcontrib><creatorcontrib>Bensoussan, Michael</creatorcontrib><creatorcontrib>Prat, Frederic</creatorcontrib><creatorcontrib>Chaussade, Stanislas</creatorcontrib><title>Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial</title><title>Gut</title><addtitle>Gut</addtitle><addtitle>Gut</addtitle><description>ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design.DesignA prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity.Results125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p<0.001). At the same time, the prevalence LGD was 34.3% (95% CI 18.6 to 50.0) in the RFA group vs 58.1% (95% CI 40.7 to 75.4) in the surveillance group (OR=0.38 (95% CI 0.14 to 1.02), p=0.05). Neoplastic progression was found in 12.5% (RFA) vs 26.2% (surveillance; p=0.15). The complication rate was maximal after the first RFA treatment (16.9%).ConclusionRFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD.Trial registration number NCT01360541.</description><subject>Ablation</subject><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - pathology</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Barrett Esophagus - diagnostic imaging</subject><subject>Barrett Esophagus - pathology</subject><subject>Barrett Esophagus - therapy</subject><subject>Barrett's oesophagus</subject><subject>Biopsy</subject><subject>Catheters</subject><subject>Disease Progression</subject><subject>Dysplasia</subject><subject>endoscopic procedures</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Eradication</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Hospitals, High-Volume</subject><subject>Hospitals, Low-Volume</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Intestine</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Metaplasia</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>oesophageal cancer</subject><subject>Oesophagus</subject><subject>Pathology</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Radiofrequency ablation</subject><subject>Radiofrequency Ablation - adverse effects</subject><subject>Surveillance</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Watchful Waiting</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkc1u1DAUhSMEokPhBVggS2xgkeK_-IddqQpFGokNrC3HcWY8cuJgO61mx2uw6Mv1SfAowyCxQKws-3733ON7quolghcIEfZuM-fd6GsMMawJxlDgR9UKUSbKTYjH1QpCxOuGU3lWPUtpByEUQqKn1RkhTDSSyVV1fz12IZkwOQOi7lzoo_0-29HsgW69zi6MIESQ5nhrnfd6NBa4EUylYsecwJ3LW_BBx2hzfvjxM4FgU5i2ejMfayaMvYuD7YAPd_WmzLCg26fJ6-T0e6DBMPvsTBGLtjgobgaXCp2j0_559aTXPtkXx_O8-vbx-uvVTb3-8unz1eW6binFuSaQcAg7xDvUEsaRaaXoCWwZ5Zz1CGqJBdaCMYpRJxre9LbH2mCEMKdcU3JevV10t9qrKbpBx70K2qmby7U6vEFKOSQS36LCvlnYKYayqZRVMWzsYTc2zElhKiWRhCBW0Nd_obswx7H8ROEGF9eMUFkovFAmhpSi7U8OEFSHoNUStDoErZagS9Oro_TcluWeWn4nW4B6Adph93-CF3_4k81_NPwCmUDE3A</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Barret, Maximilien</creator><creator>Pioche, Mathieu</creator><creator>Terris, Benoit</creator><creator>Ponchon, Thierry</creator><creator>Cholet, Franck</creator><creator>Zerbib, Frank</creator><creator>Chabrun, Edouard</creator><creator>Le Rhun, Marc</creator><creator>Coron, Emmanuel</creator><creator>Giovannini, Marc</creator><creator>Caillol, Fabrice</creator><creator>Laugier, René</creator><creator>Jacques, Jeremie</creator><creator>Legros, Romain</creator><creator>Boustiere, Christian</creator><creator>Rahmi, Gabriel</creator><creator>Metivier-Cesbron, Elodie</creator><creator>Vanbiervliet, Geoffroy</creator><creator>Bauret, Paul</creator><creator>Escourrou, Jean</creator><creator>Branche, Julien</creator><creator>Jilet, Lea</creator><creator>Abdoul, Hendy</creator><creator>Kaddour, Nadira</creator><creator>Leblanc, Sarah</creator><creator>Bensoussan, Michael</creator><creator>Prat, Frederic</creator><creator>Chaussade, Stanislas</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-0566-7870</orcidid><orcidid>https://orcid.org/0000-0002-6482-2375</orcidid><orcidid>https://orcid.org/0000-0002-9452-1450</orcidid><orcidid>https://orcid.org/0000-0002-6802-2121</orcidid><orcidid>https://orcid.org/0000-0003-2251-9076</orcidid></search><sort><creationdate>20210601</creationdate><title>Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial</title><author>Barret, Maximilien ; Pioche, Mathieu ; Terris, Benoit ; Ponchon, Thierry ; Cholet, Franck ; Zerbib, Frank ; Chabrun, Edouard ; Le Rhun, Marc ; Coron, Emmanuel ; Giovannini, Marc ; Caillol, Fabrice ; Laugier, René ; Jacques, Jeremie ; Legros, Romain ; Boustiere, Christian ; Rahmi, Gabriel ; Metivier-Cesbron, Elodie ; Vanbiervliet, Geoffroy ; Bauret, Paul ; Escourrou, Jean ; Branche, Julien ; Jilet, Lea ; Abdoul, Hendy ; Kaddour, Nadira ; Leblanc, Sarah ; Bensoussan, Michael ; Prat, Frederic ; Chaussade, Stanislas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b442t-303700d17d1b3671cb98f30b64776f10a9282a866421d8575fef2ac2112747a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Ablation</topic><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - pathology</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Barrett Esophagus - diagnostic imaging</topic><topic>Barrett Esophagus - pathology</topic><topic>Barrett Esophagus - therapy</topic><topic>Barrett's oesophagus</topic><topic>Biopsy</topic><topic>Catheters</topic><topic>Disease Progression</topic><topic>Dysplasia</topic><topic>endoscopic procedures</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Eradication</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Hospitals, High-Volume</topic><topic>Hospitals, Low-Volume</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Intestine</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Metaplasia</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>oesophageal cancer</topic><topic>Oesophagus</topic><topic>Pathology</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Radiofrequency ablation</topic><topic>Radiofrequency Ablation - adverse effects</topic><topic>Surveillance</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Watchful Waiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barret, Maximilien</creatorcontrib><creatorcontrib>Pioche, Mathieu</creatorcontrib><creatorcontrib>Terris, Benoit</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Cholet, Franck</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Chabrun, Edouard</creatorcontrib><creatorcontrib>Le Rhun, Marc</creatorcontrib><creatorcontrib>Coron, Emmanuel</creatorcontrib><creatorcontrib>Giovannini, Marc</creatorcontrib><creatorcontrib>Caillol, Fabrice</creatorcontrib><creatorcontrib>Laugier, René</creatorcontrib><creatorcontrib>Jacques, Jeremie</creatorcontrib><creatorcontrib>Legros, Romain</creatorcontrib><creatorcontrib>Boustiere, Christian</creatorcontrib><creatorcontrib>Rahmi, Gabriel</creatorcontrib><creatorcontrib>Metivier-Cesbron, Elodie</creatorcontrib><creatorcontrib>Vanbiervliet, Geoffroy</creatorcontrib><creatorcontrib>Bauret, Paul</creatorcontrib><creatorcontrib>Escourrou, Jean</creatorcontrib><creatorcontrib>Branche, Julien</creatorcontrib><creatorcontrib>Jilet, Lea</creatorcontrib><creatorcontrib>Abdoul, Hendy</creatorcontrib><creatorcontrib>Kaddour, Nadira</creatorcontrib><creatorcontrib>Leblanc, Sarah</creatorcontrib><creatorcontrib>Bensoussan, Michael</creatorcontrib><creatorcontrib>Prat, Frederic</creatorcontrib><creatorcontrib>Chaussade, Stanislas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barret, Maximilien</au><au>Pioche, Mathieu</au><au>Terris, Benoit</au><au>Ponchon, Thierry</au><au>Cholet, Franck</au><au>Zerbib, Frank</au><au>Chabrun, Edouard</au><au>Le Rhun, Marc</au><au>Coron, Emmanuel</au><au>Giovannini, Marc</au><au>Caillol, Fabrice</au><au>Laugier, René</au><au>Jacques, Jeremie</au><au>Legros, Romain</au><au>Boustiere, Christian</au><au>Rahmi, Gabriel</au><au>Metivier-Cesbron, Elodie</au><au>Vanbiervliet, Geoffroy</au><au>Bauret, Paul</au><au>Escourrou, Jean</au><au>Branche, Julien</au><au>Jilet, Lea</au><au>Abdoul, Hendy</au><au>Kaddour, Nadira</au><au>Leblanc, Sarah</au><au>Bensoussan, Michael</au><au>Prat, Frederic</au><au>Chaussade, Stanislas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial</atitle><jtitle>Gut</jtitle><stitle>Gut</stitle><addtitle>Gut</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>70</volume><issue>6</issue><spage>1014</spage><epage>1022</epage><pages>1014-1022</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><abstract>ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design.DesignA prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity.Results125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p<0.001). At the same time, the prevalence LGD was 34.3% (95% CI 18.6 to 50.0) in the RFA group vs 58.1% (95% CI 40.7 to 75.4) in the surveillance group (OR=0.38 (95% CI 0.14 to 1.02), p=0.05). Neoplastic progression was found in 12.5% (RFA) vs 26.2% (surveillance; p=0.15). The complication rate was maximal after the first RFA treatment (16.9%).ConclusionRFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD.Trial registration number NCT01360541.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>33685969</pmid><doi>10.1136/gutjnl-2020-322082</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0566-7870</orcidid><orcidid>https://orcid.org/0000-0002-6482-2375</orcidid><orcidid>https://orcid.org/0000-0002-9452-1450</orcidid><orcidid>https://orcid.org/0000-0002-6802-2121</orcidid><orcidid>https://orcid.org/0000-0003-2251-9076</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0017-5749 |
| ispartof | Gut, 2021-06, Vol.70 (6), p.1014-1022 |
| issn | 0017-5749 1468-3288 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_04470392v1 |
| source | MEDLINE; PubMed Central |
| subjects | Ablation Adenocarcinoma - diagnostic imaging Adenocarcinoma - pathology Aged Anesthesia Barrett Esophagus - diagnostic imaging Barrett Esophagus - pathology Barrett Esophagus - therapy Barrett's oesophagus Biopsy Catheters Disease Progression Dysplasia endoscopic procedures Endoscopy Endoscopy, Gastrointestinal Eradication Esophageal cancer Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - pathology Esophagus Female Hospitals, High-Volume Hospitals, Low-Volume Human health and pathology Humans Hépatology and Gastroenterology Intestine Life Sciences Male Metaplasia Middle Aged Morbidity oesophageal cancer Oesophagus Pathology Patients Prospective Studies Radiofrequency ablation Radiofrequency Ablation - adverse effects Surveillance Time Factors Treatment Outcome Watchful Waiting |
| title | Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial |
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