Durante lo studio non sono intercorse complicanze come perforazioni, sanguinamento o morte del paziente. Nel periodo di follow-up successivo non sono stati riscontrati casi di stenosi del lume esofageo. Subito dopo l’intervento 3 pazienti hanno sviluppato febbricola e lamentato dolore retrosternale, prontamente risolti dalla terapia medica (analgesici e antipiretici).
Conclusioni
Questo studio rappresenta l’esperienza iniziale – fra le prime in Italia – della S.D di Chirurgia dell’Esofago di Pisa in collaborazione con la U.O. Gastroenterologia Universitaria, del trattamento endoscopico ablativo dell’esofago di Barrett e delle lesioni precancerose mediante radiofrequenza.
Numerosi studi presenti in letteratura hanno valutato positivamente l’efficacia e la sicurezza della procedura, che al momento trova indicazione nel trattamento della displasia severa insorta su Barrett. Ulteriori studi sono in corso per valutare le indicazioni al trattamento anche della displasia lieve o dei casi di long-Barrett non displasico.
Dagli studi presenti in letteratura la tecnica risulta essere molto efficace, con percentuali di eradicazione completa della displasia variabili dal 79% al 100% e percentuali di eradicazione completa della metaplasia intestinale variabili dal 67% al 100%.
0 2 4 6 8 10 12 Pre HALO360 Re DO HGD LGD NDBE NO META
Anche le complicanze risultano nettamente inferiori rispetto ad altre tecniche e in particolare per ciò che concerne le stenosi esofagee descritte in percentuali variabili fra 0 e 4,0%.
Il presente studio, anche se con una casistica di pazienti trattati non particolarmente numerosa, conferma i dati della letteratura: la completa eradicazione della displasia è stata ottenuta nel 100% dei casi già dopo il primo trattamento con RFA. La metaplasia intestinale, dopo il primo trattamento è stata eradicata nel 75% dei casi, percentuale che dopo un secondo trattamento risulta notevolmente aumentata, attestandosi al 92%.
Durante il trattamento ed il successivo follow-up non si sono riscontrate complicanze maggiori come perforazione, sanguinamento o stenosi; non si sono osservati casi di mortalità (0%).
Questa tecnica è risultata molto efficace e sicura per il trattamento di tutti i gradi dell’esofago di Barrett, candidandosi ad essere la tecnica elettiva per la cura di quest’ultimo e per la prevenzione della progressione neoplastica dei suoi gradi di displasia
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