Table 1.
Histologic response rates reported for studies of ablation of intestinal metaplasia and dysplasia in Barrett's esophagus
| Study | Sample size/type of dysplasia | Length of follow-up | Complete histologic IM eradication at first reported follow-up (%) | Complete eradication dysplasia (%) | Persistence of IM eradication after initial response (note that times to follow-up vary) | Eradication of all BE at end of study (%) |
|---|---|---|---|---|---|---|
| MPEC | ||||||
| Sampliner et al. [25] | 58 NDBE | 6 mo | 78% | n/a | n/a | n/a |
| APC | ||||||
| Bright et al. [29] | 40 no HGD 20 APC 20 surveillance |
68 mo mean | n/a | n/a | n/a | At 5 y follow-up 40% (8/20) APC group had complete regression vs 20% (4/20) surveillance group |
| PDT | ||||||
| Ackroyd et al. [32] | 36 LGD 18 PDT 18 placebo |
24 mo | No complete eradications (by design) | 100% PDT in treated area 33% placebo |
n/a | n/a |
| Overholt et al. [10, 33] | 208 HGD 138 PDT 70 omeprazole |
24 mo and then 5 y | 52% PDT 7% omeprazole |
For all dysplasia: 59% PDT and 4% omeprazole |
n/a | n/a |
| For HGD: 77% PDT 39% omeprazole |
||||||
| Badreddine et al. [34] | 363: 12 NDBE, 56 LGD, 190 HGD, 105 intramucosal carcinoma (EMR used with PDT in some) | 36 mo median | 48% overall (175/363) | 72% (261/363) with reduction in dysplasia after PDT (unknown how many had complete eradication of dysplasia) | Number with recurrent BE unknown; 83% without return of dysplasia | n/a |
| APC vs Electrocoagulation | ||||||
| Dulai et al. [27] | 52: 51 NDBE, 1 LGD 26 MPEC 26 APC |
Unknown | 81% MPEC 65% APC |
n/a | n/a | n/a |
| Sharma et al. [28] | 35: 32 NDBE, 3 LGD 16 MPEC 19 APC |
2 y minimum | Complete response 83% for both groups | n/a | 83% (24/29) | After 2 y, 24/35 (68%) of patients had complete response (75% [12/16] MPEC, 63% ([12/19] APC) |
| PDT vs APC | ||||||
| Hage et al. [35] | 40: 32 NDBE, 8 LGD 13 PDT single dose 12 PDT fractionated doses 14 APC |
18 mo | PDT single dose 8% PDT fractionated doses 33% APC 36% |
n/a | n/a | PDT single dose 75% PDT fractionated doses 88% APC 67% (Some received additional APC following initial study treatment) |
| Kelty et al. [36] | 68 NDBE 34 PDT 34 APC |
12 mo median | PDT 38% APC 77% |
n/a | n/a | n/a |
| RFA | ||||||
| Roorda et al. [40] | 13: 6 NDBE, 4 LGD, 3 HGD | 12 mo mean | 46% (6/13) | 71% (5/7) | n/a | n/a |
| Sharma et al. [37], Fleischer et al. [38, 39] | 32 in dosimetry and 70 in effectiveness all NDBE | 2.5 y and 5 y | 59% (19/32) dosimetry 69% (48/70) effectiveness at 12 mo |
n/a | 2.5 y: 97% (60/62) 59 patients were treated with focal ablation during the follow-up period 5 y: 92% (46/50) |
2.5 y: 86% (60/70) 59 patients were treated with focal ablation during the follow-up period 5 y: 66% (46/70) |
| Gondrie et al. [41] | 11: 2 LGD, 9 HGD | 14 mo median | 100% | 100% | n/a | n/a |
| Gondrie et al. [42] | 12: 11 HGD, 1 LGD | 14 mo median | 100% | 100% | n/a | n/a |
| Sharma et al. [43] | 10 LGD | 24 mo | 70% at 1 year | 90% at 1 year | n/a | 90% at 2 y (after additional ablations) |
| Hernandez et al. [44] | 10: 7 NDBE, 2 LGD, 1 HGD | 12 mo | 70% | n/a | n/a | n/a |
| Ganz et al. [46] | 142 HGD | 12 mo median | 54% | 80% | n/a | n/a |
| Sharma et al. [45] | 63: 39 LGD, 24 HGD | 24 mo median | 79% | 89% | n/a | n/a |
| Eldaif et al. [56] | 27: 22 NDBE, 2 LGD | 0 | 100% | n/a | n/a | n/a |
| Shaheen et al. [9] | 127: 64 with LGD and 63 with HGD 84 RFA 43 sham procedure |
12 mo | 77% RFA 2% sham control |
90% RFA 23% sham control |
n/a | n/a |
| Velanovich et al. [48] | 66: 12 HGD | ? | 59% | n/a | n/a | 93% at 1 y (additional ablations between assessments) |
| Pouw et al. [47] | 24 23 underwent endoscopic resection first |
0 | 88% | 95% | n/a | n/a |
| Vassiliou et al. [49] | 15 with follow-up biopsies: 1 NDBE, 6 LDG, 15 HGD, 3 intramucosal carcinoma | 20 mo median | 73% | ? | n/a | n/a |
| Cryospray | ||||||
| Johnston et al. [50] | 11: varying degrees dysplasia | 6 mo | 78% | 100% | n/a | n/a |
| Dumot et al. [51] | 31 HGD or intramucosal adenocarcinoma | 12 mo median | 16% | 33% | n/a | 3% |
| Shaheen et al. [57] | 60 HGD (many had received previous therapy) | 10.5 mo mean | 57% | 97% | n/a | n/a |
| EMR | ||||||
| Chennat et al. [31] | 49 HGD and intramucosal carcinoma; 32 completed protocol | 17 mo median | 100% of the 32 who completed protocol 65% intention to treat | 100% of the 32 who completed protocol 65% intention to treat | 97% | 63% intention to treat |
| Pouw et al. [54] | 169 high-grade intraepithelial neoplasia or early cancer | 32 mo median | 89% | 99% (all neoplasia eradicated) | 88% | 81% |
APC—argon plasma coagulation; BE—Barrett's esophagus; EMR—endoscopic mucosal resection; HGD—high-grade dysplasia; IM—intestinal metaplasia; LGD—low-grade dysplasia; MPEC—multipolar electrocoagulation; n/a—not available; NDBE—nondysplastic Barrett's esophagus; PDT—photodynamic therapy; RFA—radiofrequency ablation