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Observatoire du traitement endoscopique par radiofréquence de l’œsophage de Barrett avec dysplasie ou de néoplasie : modalités et résultats

French registry of endoscopic radiofrequency ablation of Barrett’s oesophagus with dysplasia or neoplasia: methods and results

  • Article Original / Original Article
  • Published:
Acta Endoscopica

Résumé

Position du problème

La radiofréquence de l’œsophage (RFO) est un traitement endoscopique disponible dans la palette des méthodes de traitement endoscopique de l’œsophage de Barrett (OB). Son efficacité et faible morbidité de gravité modérée ont été démontrées dans des études prospectives et/ou randomisées.

Objectif

Décrire l’utilisation de la RFO au quotidien, ses résultats et les lésions pour lesquelles elle est utilisée par les centres experts depuis sa disponibilité en France.

Méthodes et patients

Enquête rétrospective nationale des 100 premiers patients ayant été traités partiellement ou totalement par RFO. Parmi les 100 premiers patients seulement 94 étaient atteints d’œsophage de Barrett sans dysplasie (OBND) (n = 20), avec dysplasie de bas grade (DBG) (n = 26), de haut grade (n = 40) ou au stade de carcinome (n = 8) après un premier traitement endoscopique qui avait été utilisé chez 41 patients.

Résultats

Après 98 séances de RFO circulaires chez 78 patients et 80 séances de RFO sectorielles chez 52 patients et un suivi de cinq mois (extrêmes: 1–28) après la première séance de RFO, une disparation des lésions évoluées (carcinome ou dysplasie de haut grade [DHG]) était obtenue chez 78 % des patients et des lésions peu évoluées (DBG ou OBND) chez 52 % des patients. L’éradication complète des lésions de type carcinome et/ou dysplasie, y compris de la métaplasie intestinale était obtenue dans 44 % (n = 23/53) des cas avec lésions carcinomateuses ou dysplasiques et pour 27/66 (41 %) de la totalité des patients (30 % de perdus de vue). Une sténose œsophagienne est survenue chez cinq patients (5,6 %), résolutive après deux dilatations hydrauliques endoscopiques.

Conclusions

Notre observatoire rétrospectif confirme l’efficacité de la RFO sur la disparition des lésions de dysplasie 66 % avec une faible morbidité de sévérité modérée (4,5 %) et un taux de 5,6 % de sténose œsophagienne résolutive. Il montre également que 34 % des traitements par RFO sont utilisés en France chez des patients avec OB sans dysplasie ni carcinome.

Abstract

Background

Radiofrequency ablation of the oesophagus (RFAO) is one of the many endoscopic treatment methods available for Barrett’s oesophagus. Its effectiveness and low morbidity of moderate severity has been demonstrated in prospective and/or randomised trials.

Aims

To describe the day-to-day use of RFAO, its results and the lesions it is to be used on by the experts, since becoming available in France.

Methods and Patients

Retrospective national study of first 100 patients that had been treated, either partially or totally, by RFAO. Among the first 100 patients, only 94 were affected by Barrett’s oesophagus without dysplasia (N = 20), with low grade dysplasia (N = 26), with high grade dysplasia (N = 40) or carcinoma (N = 8) after an initial endoscopic treatment, which was used on 41 patients.

Results

After 98 sessions of circular RFAO on 78 patients, and 80 sessions of sector-based RFAO on 52 patients, and a follow-up after five months (extr: 1–28) after the first session of RFAO, a disappearance in developed lesions (carcinoma or HGD) was achieved in 78% of patients, and for low developed lesions (LGD or OBND) in 52% of patients. Complete eradication of carcinoma and/or dysplastic type lesions, including intestinal metaplasia, was achieved in 44% (N = 23/53) of cases of carcinogenic or dysplastic lesions and for 27/66 (41%) of all patients (30% with loss seen). Oesophageal stenosis occurred in five patients (5.6%), which was corrected after two endoscopic hydraulic dilations.

Conclusions

Our retrospective study confirms the effectiveness of RFAO in the removal of dysplastic lesions, 66% with low morbidity of moderate severity (4.5%) and a rate of 5.6% in corrective oesophageal stenosis. It also showed that 34% of treatments using RFAO were used in France in patients with Barrett’s oesophagus without dysplasia or carcinoma.

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Author information

Authors and Affiliations

  1. Unité d’endoscopie digestive et bronchique, centre hospitalier de Cannes, F-06400, Cannes, France

    D. Heresbach

  2. IPC Marseille, Marseille, France

    F. Caillol & M. Giovannini

  3. CHU de Brest, Brest, France

    F. Cholet

  4. CHU de Bordeaux, Bordeaux, France

    A. Lamoulliate

  5. CHU d’Angers, Angers, France

    D. Luet & J. Boyer

  6. CHU de Nantes, Nantes, France

    M. Le Rhun

  7. HEGP de l’AP-HP, Paris, France

    G. Rahmi

  8. CHU de Nice, Nice, France

    G. Vanbiervliet

  9. Hôpital P Grace, Monaco, France

    J. -F. Demarquay

  10. Affaires financières et système d’information, centre hospitalier de Cannes, Cannes, France

    C. Marais

  11. HEH, CHU de Lyon, Lyon, France

    T. Ponchon

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  1. D. Heresbach
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  2. F. Caillol
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  13. J. Boyer
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Correspondence to D. Heresbach.

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Heresbach, D., Caillol, F., Cholet, F. et al. Observatoire du traitement endoscopique par radiofréquence de l’œsophage de Barrett avec dysplasie ou de néoplasie : modalités et résultats. Acta Endosc 42, 47–51 (2012). https://doi.org/10.1007/s10190-012-0234-8

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  • DOI: https://doi.org/10.1007/s10190-012-0234-8

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