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【NEJM】射频消融治疗Barrett食管的发育异常
原文链接：http://content.nejm.org/cgi/content/full/360/22/2277
Background Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma. We assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's esophagus and decrease the rate of neoplastic progression.
Methods In a multicenter, sham-controlled trial, we randomly assigned 127 patients with dysplastic Barrett's esophagus in a 2:1 ratio to receive either radiofrequency ablation (ablation group) or a sham procedure (control group). Randomization was stratified according to the grade of dysplasia and the length of Barrett's esophagus. Primary outcomes at 12 months included the complete eradication of dysplasia and intestinal metaplasia.
Results In the intention-to-treat analyses, among patients with low-grade dysplasia, complete eradication of dysplasia occurred in 90.5% of those in the ablation group, as compared with 22.7% of those in the control group (P<0.001). Among patients with high-grade dysplasia, complete eradication occurred in 81.0% of those in the ablation group, as compared with 19.0% of those in the control group (P<0.001). Overall, 77.4% of patients in the ablation group had complete eradication of intestinal metaplasia, as compared with 2.3% of those in the control group (P<0.001). Patients in the ablation group had less disease progression (3.6% vs. 16.3%, P=0.03) and fewer cancers (1.2% vs. 9.3%, P=0.045). Patients reported having more chest pain after the ablation procedure than after the sham procedure. In the ablation group, one patient had upper gastrointestinal hemorrhage, and five patients (6.0%) had esophageal stricture.
Conclusions In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a reduced risk of disease progression. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 初译：Radiofrequency Ablation in Barrett's Esophagus with Dysplasia
射频消融治疗Barrett食管的发育异常
Background Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma. We assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's esophagus and decrease the rate of neoplastic progression.
Barrett食管的背景，作为一种食管肠化生的情况，与发生食管腺癌的风险增加有关。我们评估内窥镜下射频消融是否可以根治发育异常的Barrett食管以及减少肿瘤进展的程度。
Methods In a multicenter, sham-controlled trial, we randomly assigned 127 patients with dysplastic Barrett's esophagus in a 2:1 ratio to receive either radiofrequency ablation (ablation group) or a sham procedure (control group). Randomization was stratified according to the grade of dysplasia and the length of Barrett's esophagus. Primary outcomes at 12 months included the complete eradication of dysplasia and intestinal metaplasia.
在一项多中心的对照试验，我们把127例发育异常的Barrett食管病人按照2：1的比率随机分为射频消融组和假手术组（对照组）。按照发育异常的程度及Barrett食管的长度逐层进行随机化。在12个月的时候，主要的结果包括发育异常和肠化生的彻底根治。
Results In the intention-to-treat analyses, among patients with low-grade dysplasia, complete eradication of dysplasia occurred in 90.5% of those in the ablation group, as compared with 22.7% of those in the control group (P<0.001). Among patients with high-grade dysplasia, complete eradication occurred in 81.0% of those in the ablation group, as compared with 19.0% of those in the control group (P<0.001). Overall, 77.4% of patients in the ablation group had complete eradication of intestinal metaplasia, as compared with 2.3% of those in the control group (P<0.001). Patients in the ablation group had less disease progression (3.6% vs. 16.3%, P=0.03) and fewer cancers (1.2% vs. 9.3%, P=0.045). Patients reported having more chest pain after the ablation procedure than after the sham procedure. In the ablation group, one patient had upper gastrointestinal hemorrhage, and five patients (6.0%) had esophageal stricture.
结果：在意向治疗分析中，对低等级发育异常的病人，彻底根治发育异常的比率在射频消融组为90.5%，在对照组为22.7%(P<0.001)。对高等级发育异常的病人，彻底根治发育异常的比率在射频消融组为81.0%，在对照组为19.0%(P<0.001)。总之，射频消融组77.4%的病人完全根治了肠化生，对照组为2.3%(P<0.001)。射频消融组的病人有更少的疾病进展(3.6% vs. 16.3%, P=0.03)和更少的癌症(1.2% vs. 9.3%, P=0.045)。报道射频消融后比假手术后有病人的博那个人发生胸痛。在射频消融组，一例病人有上消化到出血，5例病人（6.0%）有食管的狭窄。
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作者:admin@医学,生命科学 2010-11-02 22:43
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