Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)

K Nadine Phoa; Roos E Pouw; Raf Bisschops; Oliver Pech; Krish Ragunath; Bas L A M Weusten; Brigitte Schumacher; Bjorn Rembacken; Alexander Meining; Helmut Messmann; Erik J Schoon; Liebwin Gossner; Jayan Mannath; C A Seldenrijk; Mike Visser; Toni Lerut; Stefan Seewald; Fiebo J ten Kate; Christian Ell; Horst Neuhaus; Jacques J G H M Bergman

doi:10.1136/gutjnl-2015-309298

Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)

K Nadine Phoa
, Roos E Pouw
, Raf Bisschops
, Oliver Pech
, Krish Ragunath
, Bas L A M Weusten
, Brigitte Schumacher
, Bjorn Rembacken
, Alexander Meining
, Helmut Messmann
, Erik J Schoon
, Liebwin Gossner
, Jayan Mannath
, C A Seldenrijk
, Mike Visser
, Toni Lerut
, Stefan Seewald
, Fiebo J ten Kate
, Christian Ell
, Horst Neuhaus

Jacques J G H M Bergman

Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium.
Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany.
Department of Gastroenterology, Queens Medical Centre, Nottingham, UK.
Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus, Düsseldorf, Germany.
Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK.
Department of Gastroenterology, Klinikum rechts der Isar, Munich, Germany.
Department of Gastroenterology, Augsburg Hospital, Augsburg, Germany.
Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands.
Department of Internal Medicine II, Karlsruhe Hospital, Karlsruhe, Germany.
Department of Pathology, Pathologie-DNA BV, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Department of Pathology, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. [email protected].
Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.

DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter.

OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.

RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.

CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.

TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl.

Original language	English
Pages (from-to)	555-62
Number of pages	8
Journal	Gut
Volume	65
Issue number	4
DOIs	https://doi.org/10.1136/gutjnl-2015-309298
Publication status	Published - Apr 2016

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
Barrett Esophagus/pathology
Biopsy
Catheter Ablation/methods
Esophageal Neoplasms/pathology
Esophagoscopy/methods
Europe
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Precancerous Conditions/pathology
Prospective Studies
Treatment Outcome

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10.1136/gutjnl-2015-309298

Multimodality-endoscopic-eradication-for-neoplastic-barrett-oesophagus.pdfFinal published version, 658 KBLicence: Taverne

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Phoa, K. N., Pouw, R. E., Bisschops, R., Pech, O., Ragunath, K., Weusten, B. L. A. M., Schumacher, B., Rembacken, B., Meining, A., Messmann, H., Schoon, E. J., Gossner, L., Mannath, J., Seldenrijk, C. A., Visser, M., Lerut, T., Seewald, S., ten Kate, F. J., Ell, C., ... Bergman, J. J. G. H. M. (2016). Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut, 65(4), 555-62. https://doi.org/10.1136/gutjnl-2015-309298

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title = "Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)",

abstract = "OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50\% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter.OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90\%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92\%) and CE-IM in 115/132 patients (87\%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98\% and 93\%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4\% and 8\%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19\%); all managed conservatively or endoscopically.CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Barrett Esophagus/pathology, Biopsy, Catheter Ablation/methods, Esophageal Neoplasms/pathology, Esophagoscopy/methods, Europe, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Precancerous Conditions/pathology, Prospective Studies, Treatment Outcome",

author = "Phoa, \{K Nadine\} and Pouw, \{Roos E\} and Raf Bisschops and Oliver Pech and Krish Ragunath and Weusten, \{Bas L A M\} and Brigitte Schumacher and Bjorn Rembacken and Alexander Meining and Helmut Messmann and Schoon, \{Erik J\} and Liebwin Gossner and Jayan Mannath and Seldenrijk, \{C A\} and Mike Visser and Toni Lerut and Stefan Seewald and \{ten Kate\}, \{Fiebo J\} and Christian Ell and Horst Neuhaus and Bergman, \{Jacques J G H M\}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

month = apr,

doi = "10.1136/gutjnl-2015-309298",

language = "English",

volume = "65",

pages = "555--62",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

number = "4",

}

Phoa, KN, Pouw, RE, Bisschops, R, Pech, O, Ragunath, K, Weusten, BLAM, Schumacher, B, Rembacken, B, Meining, A, Messmann, H, Schoon, EJ, Gossner, L, Mannath, J, Seldenrijk, CA, Visser, M, Lerut, T, Seewald, S, ten Kate, FJ, Ell, C, Neuhaus, H & Bergman, JJGHM 2016, 'Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)', Gut, vol. 65, no. 4, pp. 555-62. https://doi.org/10.1136/gutjnl-2015-309298

TY - JOUR

T1 - Multimodality endoscopic eradication for neoplastic Barrett oesophagus

T2 - results of an European multicentre study (EURO-II)

AU - Phoa, K Nadine

AU - Pouw, Roos E

AU - Bisschops, Raf

AU - Pech, Oliver

AU - Ragunath, Krish

AU - Weusten, Bas L A M

AU - Schumacher, Brigitte

AU - Rembacken, Bjorn

AU - Meining, Alexander

AU - Messmann, Helmut

AU - Schoon, Erik J

AU - Gossner, Liebwin

AU - Mannath, Jayan

AU - Seldenrijk, C A

AU - Visser, Mike

AU - Lerut, Toni

AU - Seewald, Stefan

AU - ten Kate, Fiebo J

AU - Ell, Christian

AU - Neuhaus, Horst

AU - Bergman, Jacques J G H M

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter.OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl.

AB - OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter.OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Barrett Esophagus/pathology

KW - Biopsy

KW - Catheter Ablation/methods

KW - Esophageal Neoplasms/pathology

KW - Esophagoscopy/methods

KW - Europe

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Precancerous Conditions/pathology

KW - Prospective Studies

KW - Treatment Outcome

U2 - 10.1136/gutjnl-2015-309298

DO - 10.1136/gutjnl-2015-309298

M3 - Article

SN - 0017-5749

VL - 65

SP - 555

EP - 562

JO - Gut

JF - Gut

IS - 4

ER -

Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II)

Abstract

UN SDGs

Keywords

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