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Nguyen CL, Tovmassian D, Zhou M, Seyfi D, Gooley S, Falk GL. Durability of radiofrequency ablation for long-segment and ultralong-segment Barrett's esophagus over 10 years. Surg Endosc 2024; 38:1239-1248. [PMID: 38092973 DOI: 10.1007/s00464-023-10608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Long-term durability data for radiofrequency ablation (RFA) to prevent esophageal adenocarcinoma in long-segment (LSBE) and ultralong-segment Barrett's esophagus (ULSBE) is lacking. This study aimed to determine 10-year cancer progression, eradication, and complication rates in LSBE and ULSBE patients treated with RFA. METHODS Single-surgeon prospective database of patients with LSBE (≥ 3 to < 8 cm) and ULSBE (≥ 8 cm) who underwent RFA (2001-2021) were retrospectively analyzed. Ten-year cancer progression calculated with Kaplan-Meier analysis. Eradication rates, including complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), and rates of recurrence and complications, compared between LSBE and ULSBE groups. RESULTS Ten years after starting treatment, the cancer rate was 14.3% in 56 patients. CR-D and CR-IM rates were 87.5% and 67.9%, respectively. Relapse rates from CR-D were 1.8% and 3.6% from CR-IM. Eradication rates for dysplasia in LSBE and ULSBE patients (90.6% versus 83.3%) and IM (71.9% versus 62.5%) were not significantly different. ULSBE patients required higher mean number of ablation sessions for IM eradication (4.7 versus 3.7, p = 0.032), while complication rates including strictures (4.2% versus 6.2%), perforation (0 versus 0), and bleeding (4.2% versus 3.1%), were similar between ULSBE and LSBE patients, respectively. On multivariate analysis, shorter Barrett's segment and baseline low-grade dysplasia were associated with increased likelihood for eradication of IM and dysplasia. A total number of ablation sessions or endoscopic resections ≥ 3 was associated with reduced likelihood for eradication. CONCLUSION RFA was durable in maintaining dysplasia and IM eradication in both LSBE and ULSBE over 10 years, and with low complication rates. IM eradication was more difficult to achieve in ULSBE. Late development of cancer occurred in 14.3%.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - David Tovmassian
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Michael Zhou
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Doruk Seyfi
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Suzanna Gooley
- Sydney Heartburn Clinic, Lindfield, NSW, 2070, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia.
- Sydney Heartburn Clinic, Lindfield, NSW, 2070, Australia.
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Wei C, Rui Y, Wu Y, Ma Y, Zhou M, Kang Y, Wang Y, Liu J. [Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1120-1124. [PMID: 32929904 DOI: 10.7507/1002-1892.202002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Methods Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days). Results All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred. Conclusion The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.
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Affiliation(s)
- Changbao Wei
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Yongjun Rui
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Yongwei Wu
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Yunhong Ma
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Ming Zhou
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Yongqiang Kang
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Yapeng Wang
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
| | - Jun Liu
- Department of Orthopedics, Wuxi Ninth People's Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China
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Elsheaita A, El-Bially MA, Shamseya MM, Ahmed SS, Madkour MA, Shamseya AM, Nouh HH. Seattle protocol vs narrow band imaging guided biopsy in screening of Barrett's esophagus in gastroesophageal reflux disease patients. Medicine (Baltimore) 2020; 99:e19261. [PMID: 32080134 PMCID: PMC7034706 DOI: 10.1097/md.0000000000019261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Barrett's esophagus has 0.5% to 7% risk of progression to esophageal adenocarcinoma. The method of obtaining biopsies to diagnose Barrett's is challenging. Seattle protocol has been considered as the gold standard, however its difficulty limits its applicability in practice. Narrow band imaging guided biopsy has been proposed as an alternative.To investigate the accuracy, sensitivity, specificity and applicability of Narrow band guided biopsy as a screening tool for Barret's esophagus in gastroesophageal reflux patients.Endoscopy was done in 2 different sessions 2 weeks apart for 100 patients in Alexandria, Egypt. Patients had at least one of the following: Chronic Gastroesophageal reflux disease, frequent Gastroesophageal reflux disease, or two or more risk factors for Barrett's esophagus. All patients with known Barrett's esophagus were excluded.Seventeen patients had Barrett's esophagus either by one of the two techniques or by both, 4 patients by both methods, 7 patients by narrow band imaging alone and 6 patients by Seattle protocol alone (P < .001, κ = 0.461). Sensitivity, specificity, negative predictive value and positive predictive value for Seattle protocol were 58.8%, 100%, 92.2%, 100% vs 76.5%, 100%, 95.4%, 100% respectively for narrow band imaging. A mean of 7.73 samples/patient was taken in Seattle protocol vs 3.42 samples in narrow band imaging (P < .001). A mean of 8.63 minutes was consumed in Seattle protocol vs 2.65 minutes in narrow band imaging (P < .001).Narrow band imaging guided biopsy might have higher accuracy, sensitivity and negative predictive value as well as fewer number of biopsies and shorter time of the procedure compared to Seattle protocol which might increases its applicability as screening protocol for Barrett's esophagus. However, further larger multicentric studies are needed.
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Affiliation(s)
| | | | | | | | | | | | - Hanan Hosny Nouh
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Egypt
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Fountoulakis A, Souglakos J, Vini L, Douridas GN, Koumarianou A, Kountourakis P, Agalianos C, Alexandrou A, Dervenis C, Gourtsoyianni S, Gouvas N, Kalogeridi MA, Levidou G, Liakakos T, Sgouros J, Sgouros SN, Triantopoulou C, Xynos E. Consensus statement of the Hellenic and Cypriot Oesophageal Cancer Study Group on the diagnosis, staging and management of oesophageal cancer. Updates Surg 2019; 71:599-624. [DOI: 10.1007/s13304-019-00696-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
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Westerveld D, Khullar V, Mramba L, Ayoub F, Brar T, Agarwal M, Forde J, Chakraborty J, Riverso M, Perbtani YB, Gupte A, Forsmark CE, Draganov P, Yang D. Adherence to quality indicators and surveillance guidelines in the management of Barrett's esophagus: a retrospective analysis. Endosc Int Open 2018; 6:E300-E307. [PMID: 29507870 PMCID: PMC5832463 DOI: 10.1055/s-0044-101351] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adherence to quality indicators and surveillance guidelines in the management of Barrett's esophagus (BE) promotes high-quality, cost-effective care. The aims of this study were (1) to evaluate adherence to standardized classification (Prague Criteria) and systematic (four-quadrant) biopsy protocol, (2) to identify predictors of practice patterns, and (3) to assess adherence to surveillance guidelines for non-dysplastic BE (NDBE). METHODS This was a single-center retrospective study of esophagogastroduodenoscopy (EGD) performed for BE (June 2008 to December 2015). Patient demographics, procedure characteristics, and histology results were obtained from the procedure report-generating database and chart review. Adherence to Prague Criteria and systematic biopsies was based on operative report documentation. Multiple logistic regression analysis was performed to identify predictors of practice patterns. Guideline adherent surveillance EGD was defined as those performed within 6 months of the recommended 3- to 5-year interval. RESULTS In total, 397 patients (66.5 % male; mean age 60.1 ± 12.5 years) had an index EGD during the study period. Adherence to Prague Criteria and systematic biopsies was 27.4 % and 24.1 %, respectively. Endoscopists who performed therapeutic interventions for BE were more likely to use the Prague Criteria (OR: 3.16; 95 %CI: 1.47 - 6.82; P < 0.01) than those who did not. Longer time in practice was positively associated with adherence to Prague Criteria (OR 1.07; 95 %CI: 1.02 - 1.12; P < 0.01) but with a lower likelihood of performing systematic biopsies (OR 0.91; 95 %CI: 0.85 - 0.97; P < 0.01). More than half (55.6 %) of patients with NDBE underwent surveillance EGD sooner (range 1 - 29 months) than the recommended interval. CONCLUSION Adherence to quality indicators and surveillance guidelines in BE is low. Operator characteristics, including experience with endoscopic therapy for BE and time in practice predicted practice pattern. Future efforts are needed to reduce variability in practice and promote high-value care.
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Affiliation(s)
- Donevan Westerveld
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Vikas Khullar
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Lazarus Mramba
- Statistics, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Fares Ayoub
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Tony Brar
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Mitali Agarwal
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Justin Forde
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Joydeep Chakraborty
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Riverso
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Yaseen B. Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Anand Gupte
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Chris E. Forsmark
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Peter Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
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Gagner M. Comment on: an alternative view on the necessity of EGD prior to sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1964-1965. [PMID: 29055667 DOI: 10.1016/j.soard.2017.09.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Hopital du Sacre Coeur, Montreal, Canada
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