CHICAGO — Results of a multicenter study demonstrated the safety of multimodality endoscopic eradication. The most common adverse event was stricture formation while performance of endoscopic mucosal resection increased the risk of overall adverse events, according to data presented at Digestive Disease Week.
“Endoscopic eradication therapy has completely changed the management of Barrett’s esophagus-related neoplasia in the last 10 years,” Joshua C. Obuch, MD, from the University of Colorado, said in a presentation. “Much of the published data regarding adverse events in endoscopic eradication therapy is limited to small cohort size and single-center settings.”
The study comprised 642 patients. Mean patient age was 64 years, median BE length was 3 cm, 78% were men and 88% were white. Median number of endoscopic eradication therapy (EET) sessions was six.
Baseline histology of the cohort included non-displastic BE (n = 103), low-grade dysplasia (n = 194), high grade (n = 278) endoscopic adenocarcinoma (n = 65). The EET therapies underwent include radiofrequency ablation (n = 325), endoscopic mucosal resection (EMR, n = 90), combination RFA and EMR (n = 189) and cryotherapy in combination with other EET modalities.
Adverse events occurred in 73 patients with 62 patients experiencing stricture formation. In patients who underwent monotherapy RFA, strictures occurred in 6% of patients and were the most common adverse event, with perforation in one patient. In patients who underwent monotherapy EMR, strictures occurred in 7% of patients, with a 3% perforation rate, one case of severe bleeding and one case of severe hypotension. Combination therapy had a rate of 15% stricture formation and approximately 1% of patients had severe bleeding or perforation. Similarly, stricture was the most common adverse event in patients who underwent cryotherapy.
“In this large cohort, the overall adverse event rate was 12% with 83% having stricture-related disease. This data’s consistent with prior meta-analyses, with stricture formation being considerably less [common] in the EMR group. All modalities of endoscopic eradication therapy had increased odds of adverse events as radiofrequency ablation alone, and severe bleeding and cardiopulmonary events were a rare occurrence.” – by Talitha Bennett
Obuch JC, et al. Abstract 245. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
: Obuch reports no relevant financial disclosures.