In the Journals

Ablation helps improve outlook for patients with Barrett’s

Patients treated with radiofrequency ablation for Barrett’s esophagus with low-grade dysplasia felt less threatened by their condition than patients who underwent normal surveillance, according to research published in Gastrointestinal Endoscopy.

Jacques J.G.H.M. Bergman, MD, PhD, of the department of gastroenterology and hepatology at Amsterdam UMC in the Netherlands, and colleagues wrote that current guidelines recommend using radiofrequency ablation (RFA) in these patients. However, the invasive procedure can result in some serious adverse events, including post-procedure bleeding.

“Given the superiority of RFA in terms of preventing oncological progression, this risk difference is considered to be acceptable by physicians. However, little is known about perceived health of patients during RFA treatment compared with surveillance,” they wrote. “We hypothesized that ablation of confirmed [low-grade dysplasia (LGD)] may have negative short-term physical impact but improves long-term [quality of life] and alters fear and the threatening of the disease in a positive manner when compared with standard endoscopic surveillance.”

Researchers used the same population as the SURF study, which found that RFA reduced neoplastic progression from 26.5% to 1.5% when compared with standard endoscopic surveillance. They randomly assigned patients with BE with LGD to undergo RFA (n = 47) or surveillance (n = 49). Using three standardized questionnaires — SF-36 to measure generic quality of life, the cancer-specific EORTC-QLQ-C30, the EORTC-QLQ-OES18 to measure esophageal cancer specific quality of life, and the Brief Illness Perception Questionnaire (IPQ) — researchers assessed quality of life and illness perception at baseline and at 2, 9, 14, 26 and 38 months.

Bergman and colleagues found that both groups of patients reported similar quality of life. Patients who underwent RFA reported more diarrhea (7.8 vs. 4; P = .018), while patients in the surveillance group reported more reflux (15.1 vs. 9; P < .001) and more speaking problems (4.3 vs. 2.2; P = .019).

However, IPQ scores revealed that patients in the RFA group perceived that their disease lasted for a shorter time (P < .001), experienced fewer symptoms (P < .001), had fewer concerns about their condition (P < .001) and tended to be less emotionally affected by their condition (P = .012).

Bergman and colleagues wrote that as a result of these factors, patients who underwent ablation perceived their condition as less threatening compared with patients who underwent surveillance (P < .001).

“Patients in the ablation group perceived their disease as lasting for a significantly shorter period of time, experienced fewer symptoms, had fewer concerns about their condition and were less emotionally affected by their condition than patients in the surveillance group,” they wrote. “Our results strengthen the recommendation to treat selected patients with confirmed LGD in BE with RFA.” – by Alex Young

Disclosures: Bergman reports receiving funding from Covidien GI, which provided ablation devices and access to data for the study. Please see the full study for all other authors’ relevant financial disclosures.

Patients treated with radiofrequency ablation for Barrett’s esophagus with low-grade dysplasia felt less threatened by their condition than patients who underwent normal surveillance, according to research published in Gastrointestinal Endoscopy.

Jacques J.G.H.M. Bergman, MD, PhD, of the department of gastroenterology and hepatology at Amsterdam UMC in the Netherlands, and colleagues wrote that current guidelines recommend using radiofrequency ablation (RFA) in these patients. However, the invasive procedure can result in some serious adverse events, including post-procedure bleeding.

“Given the superiority of RFA in terms of preventing oncological progression, this risk difference is considered to be acceptable by physicians. However, little is known about perceived health of patients during RFA treatment compared with surveillance,” they wrote. “We hypothesized that ablation of confirmed [low-grade dysplasia (LGD)] may have negative short-term physical impact but improves long-term [quality of life] and alters fear and the threatening of the disease in a positive manner when compared with standard endoscopic surveillance.”

Researchers used the same population as the SURF study, which found that RFA reduced neoplastic progression from 26.5% to 1.5% when compared with standard endoscopic surveillance. They randomly assigned patients with BE with LGD to undergo RFA (n = 47) or surveillance (n = 49). Using three standardized questionnaires — SF-36 to measure generic quality of life, the cancer-specific EORTC-QLQ-C30, the EORTC-QLQ-OES18 to measure esophageal cancer specific quality of life, and the Brief Illness Perception Questionnaire (IPQ) — researchers assessed quality of life and illness perception at baseline and at 2, 9, 14, 26 and 38 months.

Bergman and colleagues found that both groups of patients reported similar quality of life. Patients who underwent RFA reported more diarrhea (7.8 vs. 4; P = .018), while patients in the surveillance group reported more reflux (15.1 vs. 9; P < .001) and more speaking problems (4.3 vs. 2.2; P = .019).

However, IPQ scores revealed that patients in the RFA group perceived that their disease lasted for a shorter time (P < .001), experienced fewer symptoms (P < .001), had fewer concerns about their condition (P < .001) and tended to be less emotionally affected by their condition (P = .012).

Bergman and colleagues wrote that as a result of these factors, patients who underwent ablation perceived their condition as less threatening compared with patients who underwent surveillance (P < .001).

“Patients in the ablation group perceived their disease as lasting for a significantly shorter period of time, experienced fewer symptoms, had fewer concerns about their condition and were less emotionally affected by their condition than patients in the surveillance group,” they wrote. “Our results strengthen the recommendation to treat selected patients with confirmed LGD in BE with RFA.” – by Alex Young

Disclosures: Bergman reports receiving funding from Covidien GI, which provided ablation devices and access to data for the study. Please see the full study for all other authors’ relevant financial disclosures.