dysplasia in Barrett's esophagus dysplastic Barrett mucosa
Conditions
Interventions
Radiofrequency ablation with the BARRX90-device using either the simple
regimen, or the standard regimen
Sponsors
Academisch Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. Patients aged 18-85 years. 2. BE with biopsy proven LGD, HGD or EC confirmed after expert pathology review, with residual endoscopically visible Barrett*s mucosa, with or without prior ER and/or circumferential RFA. 3. Written informed consent.
Exclusion criteria
Exclusion criteria: 1. Significant esophageal stenosis prior to the first focal RFA treatment, preventing passage of a therapeutic endoscope OR any prior endoscopic dilatation for esophageal stenosis. 2. Presence of esophageal varices. 3. Anti-coagulant therapy (apart from aspirin or NSAID) that cannot be discontinued prior to ER or RFA, OR uncorrectable hemostatic disorders. 4. In case of prior ER: a specimen showing carcinoma with positive vertical resection margins, deep submucosal invasion (>T1sm1), poorly or undifferentiated cancer (G3 or G4), or lymphatic/vascular invasion. 5. In case of prior ER: invasive cancer in any of the biopsies obtained at high-resolution endoscopy after ER. 6. Patients unable to give informed consent. 7. No justification for further treatment due to (unrelated) comorbidity.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Complete endoscopic and histological remission of IM and dysplasia after 2 focal Barrx 90 ablation sessions. Complete endoscopic eradication of IM is defined as no suspicion on residual tongues or islands of IM. If there is suspicion on residual IM, the end-point is not reached and additional RFA treatment can be performed, without taking biopsies. Complete histological eradication of IM and neoplasia is defined as absence of IM and/or neoplasia, from neo-Z-line and neosquamous biopsies obtained after 2 focal RFA sessions. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Total number of focal RFA sessions needed to reach complete remission of IM and dysplasia. The protocol allows a total number of 3 focal RFA sessions. 2. Complete endoscopic and histological remission of IM and dysplasia after 3 focal RFA sessions with or without escape treatment. At three months, the first post-treatment endoscopy will be performed with WLE and NBI, with 4-quadrant biopsies obtained from the neo-Z-line and from the neosquamous epithelium. Complete eradication of IM and neoplasia is defined as absence of IM and neoplasia, from neo-Z-line and neosquamous biopsies obtained after 3 focal RFA sessions and/or escape treatment with APC/ER. 3. Rate of esophageal stenosis requiring dilatation, occurring during the focal RFA treatment phase. Any patient who requires a dilatation session after any of the Barrx 90 procedures, is considered as having an esophageal stenosis. The number of patients with stenosis are documented, and the number of dilatation procedures required to resolve the stenosis are documented. 4. Overall complications requiring admission/unplanned endoscopy. Number and severity of acute (during the procedure), early (0-48 hours) and late (>48 hours) complications. Complications are only recorded if they are clinically significant and graded as *mild* (unplanned hospital admission, hospitalization 10 days, intensive care unit admission, need for surgery, >4 units of blood transfusion) or *fatal* (death attributable to procedure | — |
Countries
Netherlands
Outcome results
None listed