21 research outputs found
A single-step sizing and radiofrequency ablation catheter for circumferential ablation of Barrett's esophagus: Results of a pilot study
Background: The 360 Express balloon catheter (360 Express) has the ability to self-adjust to the esophageal lumen, ensuring optimal tissue contact. Objective: The objective of this article is to evaluate the efficacy and safety of the 360 Express for radiofrequency ablation (RFA) treatment of Barrett's esophagus (BE). Methods: BE patients with low-grade dysplasia (LGD), high-grade dysplasia (HGD) or early cancer (EC) were included. Visible lesions were removed by endoscopic resection (ER) prior to RFA. RFA was performed with the 360 Express using the standard ablation regimen (12J/cm2–clean–12J/cm2). Primary outcome: BE regression percentage at three months. Secondary outcomes: procedure time, adverse events, complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM). Results: Thirty patients (median BE C4M6) were included. Eight patients underwent ER prior to RFA. Median BE regression: 90%. Median procedure time: 31 minutes. Adverse events (13%): laceration (n = 1); atrial fibrillation (n = 1); vomiting and dysphagia (n = 1); dysregulated diabetes (n = 1). After subsequent treatment CE-D and CE-IM was achieved in 97% and 87%, respectively. In 10% a stenosis developed during additional treatment requiring a median of one dilation. Conclusion: This study shows that circumferential RFA using the 360 Express may shorten procedure time, while maintaining efficacy compared to standard circumferential RFA
Endoscopic tissue sampling - Part 2: lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) guideline
Cellular mechanisms in basic and clinical gastroenterology and hepatolog
Endoscopic tissue sampling - Part 1: upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) guideline
Main RecommendationsCellular mechanisms in basic and clinical gastroenterology and hepatolog
Adherence to pre-set benchmark quality criteria to qualify as expert assessor of dysplasia in Barrett’s esophagus biopsies – towards digital review of Barrett’s esophagus
Background: Dysplasia assessment of Barrett’s esophagus biopsies is associated with low observer agreement; guidelines advise expert review. We have developed a web-based review panel for dysplastic Barrett’s esophagus biopsies. Objective: The purpose of this study was to test if 10 gastrointestinal pathologists working at Dutch Barrett’s esophagus expert centres met pre-set benchmark scores for quality criteria. Methods: Ten gastrointestinal pathologists twice assessed 60 digitalized Barrett’s esophagus cases, enriched for dysplasia; then
Endoscopic eradication of Barrett's oesophagus with early neoplasia
Rosaline Pouw deed onderzoek naar endoscopische behandeling van een Barrett-slokdarm met vroege vormen van kanker. Deze is veilig en effectief. De grootste afwijkingen kunnen eerst in een kijkoperatie worden verwijderd, vervolgens kan men het resterende Barrettslijmvlies veilig en effectief weghalen met radiofrequente technieken. Deze behandelmethode resulteert bij meer dan 90 procent van de patiënten in volledige verwijdering van het Barrettslijmvlies
Endoluminal Treatment of Barrett's Esophagus: Current and Future Prospects
Endoluminal treatment of Barrett's esophagus has become the preferred
option for initial intervention for advanced neoplasia without invasive
carcinoma. Data from abstracts presented at Digestive Disease Week 2008 provide
greater insight into optimal use of existing techniques and an early look at
potential next generation therapies. Results from the AIM Dysplasia trial
describe a larger study with longer post-treatment surveillance highlighting the
efficacy and tolerability of radiofrequency ablation, while early results from
liquid nitrogen cryotherapy studies suggest a potential to obtain similar
eradication results with very high tolerability. Endoscopic resection, despite
its risks, remains a popular option for focal as well as more widespread
resection of Barrett's mucosa. Additional abstracts highlight novel
approaches to ablation and resection. Enhanced imaging techniques and molecular
marker analysis also appear to improve treatment outcomes. However, time and
further studies of combined approaches to diagnosis and eradication are
necessary to optimize treatment algorithms
Endoscopically placed fiducial markers for image-guided radiotherapy in preoperative gastric cancer: technical feasibility and potential benefit
Background and study aims Fiducial markers have demonstrated clinical value in radiotherapy in several organs, but little is known about markers in the stomach. Here, we assess the technical feasibility of endoscopic placement of markers in gastric cancer patients and their potential benefit for image-guided radiotherapy (IGRT).Patients and methods In this prospective feasibility study, 14 gastric cancer patients underwent endoscopy-guided gold (all patients) and liquid (7 patients) marker placements distributed throughout the stomach. Technical feasibility, procedure duration, and potential complications were evaluated. Assessed benefit for IGRT comprised marker visibility on acquired imaging (3–4 computed tomography [CT] scans and 19–25 cone-beam CTs [CBCTs] per patient) and lack of migration. Marker visibility was compared per marker type and location (gastroesophageal junction (i.e., junction/cardia), corpus (corpus/antrum/fundus), and pylorus).Results Of the 93 marker implantation attempts, 59 were successful, i.e., marker in stomach wall and present during entire 5-week radiotherapy course (2–6 successfully placed markers per patient), with no significant difference (Fisher’s exact test; P>0.05) in success rate between gold (39/66=59%) and liquid (20/27=74%). Average procedure duration was 24.4 min (range 16–38). No procedure-related complications were reported. All successfully placed markers were visible on all CTs, with 81% visible on ≥95% of CBCTs. Five markers were poorly visible (on Conclusions Endoscopic placement of fiducial markers in the stomach is technically feasible and safe. Being well visible and positionally stable, markers provide a potential benefit for IGRT.Cellular mechanisms in basic and clinical gastroenterology and hepatolog