Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system
This study aimed to determine the optimal treatment parameters for the ablation of intestinal metaplasia (IM) containing high-grade dysplasia (HGD) using a balloon-based ablation system for patients undergoing esophagectomy. Immediately before esophagectomy, patients underwent ablation of circumfere...
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| Veröffentlicht in: | Surgical endoscopy 2007-04, Vol.21 (4), p.560-569 |
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| creator | SMITH, C. D BEJARANO, P. A MELVIN, W. S PATTI, M. G MUTHUSAMY, R DUNKIN, B. J |
| description | This study aimed to determine the optimal treatment parameters for the ablation of intestinal metaplasia (IM) containing high-grade dysplasia (HGD) using a balloon-based ablation system for patients undergoing esophagectomy.
Immediately before esophagectomy, patients underwent ablation of circumferential segments of the esophagus containing IM-HGD using the HALO360 system. The treatment settings were randomized to 10, 12, or 14 J/cm2 for two, three, or four applications. After esophagectomy, multiple sections from ablation zones were microscopically evaluated. Histologic end points included maximum ablation depth (histologic layer) and complete ablation of all IM-HGD (yes/no).
Eight men with a mean age of 57 years (range, 45-71 years) were treated, and 10 treatment zones were created. There were no device-related adverse events. At resection, there was no evidence of a transmural thermal effect. Grossly, ablation zones were clearly demarcated sections of ablated epithelium. The maximum ablation depth was the lamina propria or muscularis mucosae. The highest energy (14 J/cm2, 4 applications) incurred edema in the superficial submucosa, but no submucosa ablation. Complete ablation of IM and HGD occurred in 9 of 10 ablation zones (90%), defined as complete removal of the epithelium with only small foci of "ghost cells" representing nonviable, ablated IM-HGD and demonstrating loss of nuclei and cytoarchitectural derangement. One focal area of viable IM-HGD remained at the margin of one ablation zone (12 J/cm2, 2 applications) because of incomplete overlap.
Complete ablation of IM-HGD without ablation of submucosa is possible using the HALO360 system. Ablation depth is dose related and limited to the muscularis mucosae. In one patient, small residual foci of IM-HGD at the edge of the ablation zone were attributable to incomplete overlap, which can be avoided. This study, together with nonesophagectomy IM-HGD trials currently underway, will identify the optimal treatment parameters for IM-HGD patients who would otherwise undergo esophagectomy or photodynamic therapy. |
| doi_str_mv | 10.1007/s00464-006-9053-3 |
| format | Article |
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Immediately before esophagectomy, patients underwent ablation of circumferential segments of the esophagus containing IM-HGD using the HALO360 system. The treatment settings were randomized to 10, 12, or 14 J/cm2 for two, three, or four applications. After esophagectomy, multiple sections from ablation zones were microscopically evaluated. Histologic end points included maximum ablation depth (histologic layer) and complete ablation of all IM-HGD (yes/no).
Eight men with a mean age of 57 years (range, 45-71 years) were treated, and 10 treatment zones were created. There were no device-related adverse events. At resection, there was no evidence of a transmural thermal effect. Grossly, ablation zones were clearly demarcated sections of ablated epithelium. The maximum ablation depth was the lamina propria or muscularis mucosae. The highest energy (14 J/cm2, 4 applications) incurred edema in the superficial submucosa, but no submucosa ablation. Complete ablation of IM and HGD occurred in 9 of 10 ablation zones (90%), defined as complete removal of the epithelium with only small foci of "ghost cells" representing nonviable, ablated IM-HGD and demonstrating loss of nuclei and cytoarchitectural derangement. One focal area of viable IM-HGD remained at the margin of one ablation zone (12 J/cm2, 2 applications) because of incomplete overlap.
Complete ablation of IM-HGD without ablation of submucosa is possible using the HALO360 system. Ablation depth is dose related and limited to the muscularis mucosae. In one patient, small residual foci of IM-HGD at the edge of the ablation zone were attributable to incomplete overlap, which can be avoided. This study, together with nonesophagectomy IM-HGD trials currently underway, will identify the optimal treatment parameters for IM-HGD patients who would otherwise undergo esophagectomy or photodynamic therapy.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-006-9053-3</identifier><identifier>PMID: 17180281</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York, NY: Springer</publisher><subject>Ablation ; Aged ; Barrett Esophagus - mortality ; Barrett Esophagus - pathology ; Barrett Esophagus - surgery ; Biological and medical sciences ; Biopsy, Needle ; Catheter Ablation - instrumentation ; Catheterization - instrumentation ; Catheters ; Endoscopy ; Equipment Design ; Equipment Safety ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagectomy - instrumentation ; Esophagectomy - methods ; Esophagus ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Immunohistochemistry ; Male ; Medical sciences ; Medicine ; Metaplasia - pathology ; Middle Aged ; Neoplasm Invasiveness - pathology ; Other diseases. Semiology ; Patients ; Photodynamic therapy ; Risk Assessment ; Stomach, duodenum, intestine, rectum, anus ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Surveillance ; Survival Analysis ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2007-04, Vol.21 (4), p.560-569</ispartof><rights>2007 INIST-CNRS</rights><rights>Springer Science+Business Media, LLC 2007</rights><rights>Springer Science+Business Media, LLC 2006.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-4a30a4769d808a6ca271dd4928b065f23e09fa94c6750aa540579128689d7d4a3</citedby><cites>FETCH-LOGICAL-c384t-4a30a4769d808a6ca271dd4928b065f23e09fa94c6750aa540579128689d7d4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18666613$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17180281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SMITH, C. D</creatorcontrib><creatorcontrib>BEJARANO, P. A</creatorcontrib><creatorcontrib>MELVIN, W. S</creatorcontrib><creatorcontrib>PATTI, M. G</creatorcontrib><creatorcontrib>MUTHUSAMY, R</creatorcontrib><creatorcontrib>DUNKIN, B. J</creatorcontrib><title>Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><description>This study aimed to determine the optimal treatment parameters for the ablation of intestinal metaplasia (IM) containing high-grade dysplasia (HGD) using a balloon-based ablation system for patients undergoing esophagectomy.
Immediately before esophagectomy, patients underwent ablation of circumferential segments of the esophagus containing IM-HGD using the HALO360 system. The treatment settings were randomized to 10, 12, or 14 J/cm2 for two, three, or four applications. After esophagectomy, multiple sections from ablation zones were microscopically evaluated. Histologic end points included maximum ablation depth (histologic layer) and complete ablation of all IM-HGD (yes/no).
Eight men with a mean age of 57 years (range, 45-71 years) were treated, and 10 treatment zones were created. There were no device-related adverse events. At resection, there was no evidence of a transmural thermal effect. Grossly, ablation zones were clearly demarcated sections of ablated epithelium. The maximum ablation depth was the lamina propria or muscularis mucosae. The highest energy (14 J/cm2, 4 applications) incurred edema in the superficial submucosa, but no submucosa ablation. Complete ablation of IM and HGD occurred in 9 of 10 ablation zones (90%), defined as complete removal of the epithelium with only small foci of "ghost cells" representing nonviable, ablated IM-HGD and demonstrating loss of nuclei and cytoarchitectural derangement. One focal area of viable IM-HGD remained at the margin of one ablation zone (12 J/cm2, 2 applications) because of incomplete overlap.
Complete ablation of IM-HGD without ablation of submucosa is possible using the HALO360 system. Ablation depth is dose related and limited to the muscularis mucosae. In one patient, small residual foci of IM-HGD at the edge of the ablation zone were attributable to incomplete overlap, which can be avoided. This study, together with nonesophagectomy IM-HGD trials currently underway, will identify the optimal treatment parameters for IM-HGD patients who would otherwise undergo esophagectomy or photodynamic therapy.</description><subject>Ablation</subject><subject>Aged</subject><subject>Barrett Esophagus - mortality</subject><subject>Barrett Esophagus - pathology</subject><subject>Barrett Esophagus - surgery</subject><subject>Biological and medical sciences</subject><subject>Biopsy, Needle</subject><subject>Catheter Ablation - instrumentation</subject><subject>Catheterization - instrumentation</subject><subject>Catheters</subject><subject>Endoscopy</subject><subject>Equipment Design</subject><subject>Equipment Safety</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - instrumentation</subject><subject>Esophagectomy - methods</subject><subject>Esophagus</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Metaplasia - pathology</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Other diseases. Semiology</subject><subject>Patients</subject><subject>Photodynamic therapy</subject><subject>Risk Assessment</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Surveillance</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kcuKFDEUhoMoTjv6AG4kKLorza1yWcowXmDAja6LU0mqO0NVUtapXvQ7-NCm6YIGwWyyyPf_4ZyPkNecfeSMmU_ImNKqYUw3jrWykU_IjispGiG4fUp2zEnWCOPUDXmB-Mgq7nj7nNxwwy0Tlu_In_scCvoyJ0-hH2FNJdMy0JTXiGvKMNIprjCPgAmoL3mFlFPe00PaH5r9AiHScMLtPWUascwH2Ee_lulE51oY84r0iOcQ0B7GsZTc9IAxXH_EE65xekmeDTBifLXdt-TXl_ufd9-ahx9fv999fmi8tGptFEgGymgXLLOgPQjDQ1BO2J7pdhAyMjeAU16blgG0irXGcWG1dcGEmr4lHy6981J-H-uc3ZTQx3GEHMsRO1N3o7lpK_juH_CxHJe6FOyE1kpwZSSv1Nv_Uty1XFnrKsQvkF8K4hKHbl7SBMup46w72-wuNrtqszvb7GTNvNmKj_0UwzWx6avA-w0A9DAOC2Sf8MpZXQ-X8i9IS6hh</recordid><startdate>20070401</startdate><enddate>20070401</enddate><creator>SMITH, C. D</creator><creator>BEJARANO, P. A</creator><creator>MELVIN, W. S</creator><creator>PATTI, M. G</creator><creator>MUTHUSAMY, R</creator><creator>DUNKIN, B. 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G ; MUTHUSAMY, R ; DUNKIN, B. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-4a30a4769d808a6ca271dd4928b065f23e09fa94c6750aa540579128689d7d4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Ablation</topic><topic>Aged</topic><topic>Barrett Esophagus - mortality</topic><topic>Barrett Esophagus - pathology</topic><topic>Barrett Esophagus - surgery</topic><topic>Biological and medical sciences</topic><topic>Biopsy, Needle</topic><topic>Catheter Ablation - instrumentation</topic><topic>Catheterization - instrumentation</topic><topic>Catheters</topic><topic>Endoscopy</topic><topic>Equipment Design</topic><topic>Equipment Safety</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - instrumentation</topic><topic>Esophagectomy - methods</topic><topic>Esophagus</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Immunohistochemistry</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Metaplasia - pathology</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Other diseases. Semiology</topic><topic>Patients</topic><topic>Photodynamic therapy</topic><topic>Risk Assessment</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Surveillance</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SMITH, C. D</creatorcontrib><creatorcontrib>BEJARANO, P. A</creatorcontrib><creatorcontrib>MELVIN, W. 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D</au><au>BEJARANO, P. A</au><au>MELVIN, W. S</au><au>PATTI, M. G</au><au>MUTHUSAMY, R</au><au>DUNKIN, B. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system</atitle><jtitle>Surgical endoscopy</jtitle><addtitle>Surg Endosc</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>21</volume><issue>4</issue><spage>560</spage><epage>569</epage><pages>560-569</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>This study aimed to determine the optimal treatment parameters for the ablation of intestinal metaplasia (IM) containing high-grade dysplasia (HGD) using a balloon-based ablation system for patients undergoing esophagectomy.
Immediately before esophagectomy, patients underwent ablation of circumferential segments of the esophagus containing IM-HGD using the HALO360 system. The treatment settings were randomized to 10, 12, or 14 J/cm2 for two, three, or four applications. After esophagectomy, multiple sections from ablation zones were microscopically evaluated. Histologic end points included maximum ablation depth (histologic layer) and complete ablation of all IM-HGD (yes/no).
Eight men with a mean age of 57 years (range, 45-71 years) were treated, and 10 treatment zones were created. There were no device-related adverse events. At resection, there was no evidence of a transmural thermal effect. Grossly, ablation zones were clearly demarcated sections of ablated epithelium. The maximum ablation depth was the lamina propria or muscularis mucosae. The highest energy (14 J/cm2, 4 applications) incurred edema in the superficial submucosa, but no submucosa ablation. Complete ablation of IM and HGD occurred in 9 of 10 ablation zones (90%), defined as complete removal of the epithelium with only small foci of "ghost cells" representing nonviable, ablated IM-HGD and demonstrating loss of nuclei and cytoarchitectural derangement. One focal area of viable IM-HGD remained at the margin of one ablation zone (12 J/cm2, 2 applications) because of incomplete overlap.
Complete ablation of IM-HGD without ablation of submucosa is possible using the HALO360 system. Ablation depth is dose related and limited to the muscularis mucosae. In one patient, small residual foci of IM-HGD at the edge of the ablation zone were attributable to incomplete overlap, which can be avoided. This study, together with nonesophagectomy IM-HGD trials currently underway, will identify the optimal treatment parameters for IM-HGD patients who would otherwise undergo esophagectomy or photodynamic therapy.</abstract><cop>New York, NY</cop><pub>Springer</pub><pmid>17180281</pmid><doi>10.1007/s00464-006-9053-3</doi><tpages>10</tpages></addata></record> |
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| subjects | Ablation Aged Barrett Esophagus - mortality Barrett Esophagus - pathology Barrett Esophagus - surgery Biological and medical sciences Biopsy, Needle Catheter Ablation - instrumentation Catheterization - instrumentation Catheters Endoscopy Equipment Design Equipment Safety Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy - instrumentation Esophagectomy - methods Esophagus Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Humans Immunohistochemistry Male Medical sciences Medicine Metaplasia - pathology Middle Aged Neoplasm Invasiveness - pathology Other diseases. Semiology Patients Photodynamic therapy Risk Assessment Stomach, duodenum, intestine, rectum, anus Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Surveillance Survival Analysis Treatment Outcome |
| title | Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system |
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