Ablación con radiofrecuencia del esófago de Barret con displasia o carcinoma in situ. Experiencia preliminary
Por:
Castaño R., Álvarez Ó., Piñeres A., Ruiz M.H., Rojas A., ÁLvarez A., Ruiz L.M., Restrepo D., Calvo V.
Publicada:
1 ene 2014
Categoría:
Gastroenterology
Resumen:
Introduction: Barrett’s esophagus (BE) is the result of chronic damage to the esophageal epithelium caused by the acid of gastrointestinal reflux diseases (GERD). It is defined as replacement of the by stratified squamous epithelium that normally lines the esophagus with metaplastic columnar epithelium. BE represents a risk factor for esophageal adenocarcinoma. The aim of radiofrequency ablation (RFA) is to destroy the metaplastic epithelium with the electric current of a radiofrequency to stimulate the reappearance of stratified squamous epithelium in the distal esophagus. Objective: The objective of this study was to evaluate the efficiency and safety of RFA which has recently been introduced in the city of Medellin, Colombia for management of BE with in situ dysplasia or carcinoma. Materials and Methods: Ten patients were treated with RFA. BE patients with in situ dysplasia or carcinoma and histological diagnoses were chosen for treatment. RFA procedures were done with BARRX equipment, the circular HALO360 system or the HALO90 system. Macroscopic and microscopic effects of RFA, patient tolerance to treatment and complications were evaluated. Results: A group of 10 patients received treatment with RFA. All ten finished treatment and follow-up. Seven patients had low-grade dysplasia, two had high-grade dysplasia, and one patient had in situ carcinoma. Two patients had undergone endoscopic resections of nodules and treatments of mucosa with bands prior to therapy with RFA. A total of 13 procedures were performed: 10 RFAs with the HALO360, 2 RFAs with the HALO90 and one argon plasma treatment for residual BE in one patient. Eradication of metaplastic and dysplastic esophageal epithelium was achieved in all patients and confirmed by endoscopic and histologic evaluation. No significant complications related to RFA were found, but in two patients esophageal stenoses were found. One required endoscopic dilatation three weeks after therapy. Conclusions: Based on these preliminary results we believe that this is a promising method that is welltolerated by patients and which has no major complications. Metaplastic and dysplastic epithelium of the distal esophagus were successfully eradicated in most patients. © 2014 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología
Filiaciones:
Castaño R.:
Universidad de Antioquia, Instituto de Cancerología Clínica las Américas, Medellín, Colombia
Medellín, Colombia
Álvarez Ó.:
Texas Valley Coastal Bend (Veterans Administration), UTHSCSA, United States
Piñeres A.:
Clínica Bolivariana, Medellín, Colombia
Medellín, Colombia
Ruiz M.H.:
Hospital Pablo Tobón Uribe, Medellín, Colombia
Medellín, Colombia
Rojas A.:
Instituto de Cancerología-Clínica las Américas, Medellín, Colombia
Medellín, Colombia
ÁLvarez A.:
Estudiantes de Pregrado, Medellín, Colombia
Medellín, Colombia
Ruiz L.M.:
Estudiantes de Pregrado, Medellín, Colombia
Medellín, Colombia
Restrepo D.:
Medellín, Colombia
Calvo V.:
Medellín, Colombia
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