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Endoscopic eradication therapy can lead to strictures in patients with Barrett's esophagus
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SAN DIEGO — Endoscopic eradication therapy can be a safe treatment strategy for patients with Barrett’s esophagus, high-grade dysplasia and early adenocarcinoma, although manageable esophageal strictures can develop, according to data presented at the 2012 Digestive Disease Week annual meeting.
In a multicenter cohort study, researched examined data from 311 patients from four tertiary referral centers throughout the United States. The participants underwent 1,231 endoscopic eradication therapy (EET) sessions, which included 359 endoscopic mucosal resections alone, 37 resections with ablative therapy, 684 radiofrequency ablations and 151 other ablative therapies, including argon plasma coagulation, cryotherapy and photodynamic therapy used in various combinations. Data on major complications, including GI bleeding, esophageal stricture rate and perforation, were collected to determine the rate of adverse events associated with the treatment.
Esophageal strictures developed in 46 patients (14.8%) and required 108 dilations (mean 2.3 per patient). Gastrointestinal hemorrhage occurred in six patients (1.9%), requiring hospitalization, and two patients (0.6%) developed esophageal perforation, one who required surgery. All complications, apart from the single surgery, were managed endoscopically. Multivariate analysis of factors, including age, gender, race, number of EET sessions performed and the duration of Barrett’s esophagus in the patient, revealed no significant predictors for complication.
“We wanted to present real-life data for patients undergoing these therapies,” researcher Sachin Wani, MD, assistant professor of medicine, University of Colorado Hospital, Denver, told Healio.com. “I think this is really important data for all physicians who embark on [EET] for Barrett’s. They need to be aware of the fact that strictures can happen, and that it can happen in almost 15% of cases. But it’s also important to note that most of the strictures can be managed endoscopically by dilation.” Wani added that identifying factors associated with the observed complications should be the subject of a future study.
For more information:
Wani S. #Su1108: Major Complications During Endoscopic Eradication Therapy (EET) for Barrett’s Esophagus (BE) With High Grade Dysplasia (HGD) and Early Cancer (EC): Results From a Large Multicenter Cohort Study. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, San Diego.