A Canadian Experience With a Protocolized Barrettʼs Endoscopic Therapy Program: Durability, Efficacy, and Outcomes From 2010-2015
Bibliographic record
Abstract
Introduction: Radiofrequency ablation (RFA), +/- Endoscopic Mucosal Resection (EMR), has been validated as a treatment option for Barrett's esophagus (BE) and early esophageal cancer. However, little is known regarding outcomes of BE therapy in Canada. We set out to evaluate the efficacy, durability and safety of these techniques in Calgary, a tertiary care center in Canada. Methods: A retrospective review of a prospectively maintained database of patients undergoing RFA+/- EMR for biopsy-proven intestinal metaplasia (IM), dysplasia (D), or intramucosal carcinoma (IMCa) from June 2010 to April 2015. Our primary outcome was the rate of complete remission of IM (CRIM) or dysplasia (CRD) defined as confirmed eradication on two negative consecutive endoscopies with biopsies. Secondary outcomes were treatment-related complications, number and type of treatments used and quality of life (QoL) based on a questionnaire previously used in the BE literature. Results: 31 patients (27 male; mean age 62± 11 years), with a mean BE length of 6.9cm (± 3.8 cm) underwent endoscopic therapy for BE from 2010 to 2014 (two with IMCa, ten with high grade dysplasia (HGD), ten with low grade dysplasia and nine with no dysplasia (ND), but additional risk factors for esophageal cancer (long segment, family history of esophageal cancer or age of BE diagnosis < 30)). EMR was also performed in 9 (29%) patients. CRIM/D were achieved in 28/31 (90.3%) of patients (see Table 1). Patients required a mean of 3.1± 1.3 RFA sessions to achieve CRD and 3.2± 1.3 RFA sessions to achieve CRIM. During a mean follow-up period of 17.9 ± 11.8 months, durable CRIM/D was achieved in 27/28 (96.4%) patients (one IM recurrence only). Treatment-related complications included stricture formation requiring balloon dilation in 2/31 (6.4%) and chest pain requiring hospitalization in 1/31 (3.1%). The main QoL outcome was 5/7 (71.4%) felt reduced stress about the present condition of their esophagus one year after starting treatment.Table 1: Patients with BE- Mean Follow Up and Response to RFA+/-EMRConclusion: In the medium term, RFA +/- EMR is a safe, effective and durable treatment option for BE in Canada. In Calgary, greater than 80% of patients achieved CRIM/D and >95% maintained CRIM/D at a mean of 18 months follow-up. Patients also perceive a reduction in stress pertaining to BE after intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".