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Endoscopic Resection plus BRRX Radiofrequency Ablation for Eradication of Barrett's Mucosa containing High-Grade Dysplasia and Early Cancer. A European Multi-Centre Cohort Study.


- candidate number3030
- NTR NumberNTR1211
- ISRCTNISRCTN wordt niet meer aangevraagd
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR10-mrt-2008
- Secondary IDsMEC 06/189 Academic Medical Center Amsterdam
- Public TitleEndoscopic Resection plus BRRX Radiofrequency Ablation for Eradication of Barrett's Mucosa containing High-Grade Dysplasia and Early Cancer. A European Multi-Centre Cohort Study.
- Scientific TitleEndoscopic Resection plus BRRX Radiofrequency Ablation for Eradication of Barrett's Mucosa containing High-Grade Dysplasia and Early Cancer. A European Multi-Centre Cohort Study.
- ACRONYMEURO-II study
- hypothesisWe hypothesize that ER of endoscopically visible abnormalities followed by stepwise circumferential and focal RFA of the residual BE will effectively remove the HGD and EC and will completely remove all Barrett's mucosa without significant complications.
- Healt Condition(s) or Problem(s) studiedBarrett's esophagus, Barrett's neoplasia, Barrett's cancer, Barrett's dysplasia, Radiofrequency ablation, Endoscopic resection, Endoscopic mucosa resection
- Inclusion criteriaInclusion criteria prior to Endoscopic Resection:
1. Patients in the age of 18-85 years with HGD or EC in a Barrett's esophagus.
2. An endoscopically visible abnormality containing HGD a/o EC and no endoscopic signs suggestive of submucosal invasion.
3. Patients with no visible abnormalities and a pretreatment diagnosis of HGD are also eligible. These patients will not undergo an ER and are directly amendable for RFA treatment.
4. Pretreatment biopsies reviewed by an expert local pathologist.
5. EUS without signs of deep submucosal invasion or suspicious local lymph nodes.
6. Normal CT-scan of thorax and upper 1/3 of the abdomen using 5-mm slices (only for patients with invasive cancer in their pretreatment biopsies or ER specimens).
7. Informed written consent.
- Exclusion criteriaExclusion criteria prior to Endoscopic Resection:
1. Patients with a Barrett's segment >12 centimeters.
2. Any prior endoscopic treatment of Barrett's neoplasia.
3. Any prior endoscopic dilatation for esophageal stenosis.
4. Patients unable to give informed consent.
Exclusion criteria based on the outcome of the ER:
1. An endoscopic resection measuring more than 50% of the esophageal circumference or more than 2 cm in longitudinal extent.
2. Patients with endoscopic resection of multiple lesions in a single ER session are not eligible if one of the resections measures more than the aforementioned size criteria, OR if resections of different lesions are not separated by a free circumferential segment of at least 1 cm.
3. Positive vertical resection margins, deep submucosal invasion (T1sm2), poorly or undifferentiated cancer (G3 or G4), or lymphatic/vascular invasion in any of the ER specimens.
4. Remaining visible abnormalities suggestive of possible submucosal ingrowth: type 0-Is, type 0-III or otherwise according to the discretion of the endoscopist.
5. Symptomatic dysphagia or esophageal dilatation after the ER.
6. Invasive cancer in any of the biopsies obtained at high-resolution endoscopy after the ER: biopsies should be reviewed in Amsterdam before patients are excluded based on this criterion.
7. An interval > 3 months between the last high-resolution endoscopy with biopsies and RFA.
8. An interval < 6 weeks between ER and RFA.
9. Patients unable to give informed consent.
- mec approval receivedyes
- multicenter trialyes
- randomisedno
- group[default]
- TypeSingle arm
- Studytypeintervention
- planned startdate 1-sep-2007
- planned closingdate1-dec-2009
- Target number of participants100
- InterventionsEndoscopic resection (ER) of visible lesions and early cancer (EC) followed by radiofrequency ablation (RFA) of the residual Barrett's epithelium.
- Primary outcomePrimary clinical outcome parameters assessed at t=6 and t=12 months:
1. Rate of total histological eradication of HGD and EC
2. Rate of total endoscopic eradication of Barrett's mucosa
3. Rate of total histological eradication of Barrett's mucosa
- Secondary outcomeSecondary outcome parameters
1. Acute and late complications of ER and RFA
2. Percentage of surface regression of Barrett's epithelium
3. Number of treatment sessions required to eradicate all Barrett's mucosa
- TimepointsTreatment
- T=0, at inclusion: ER of focal abnormalities, followed by biopsies of the residual Barrett's segment during the same procedure.
- Between 3 months to 1 week prior to RFA: high-resolution endoscopy with biopsies according to the Seattle protocol.
- T=6 weeks: first RFA-treatment (HALO-360) (delay with a maximum of 12 months after ER is allowed, provided that HRE with 4QBx/2 cm is performed at least twice, the last within 3 months to 1 week prior to RFA).
- T=12 weeks: endoscopy RFA. It is expected that the majority of patients will require some form of additional RFA. For isolated islands with a maximum length of 2 cm and less than 50% of the circumference RFA will be performed with the HALO-90 RFA device. For larger areas of residual Barrett's mucosa, RFA will be performed using the HALO-360 RFA balloon. It is expected that <10% of patients will require a second ablation with the HALO-360 system. Those patients who undergo a second HALO-360 treatment are amendable for two additional HALO-90 treatments.
- T=18 weeks: endoscopy RFA. For isolated islands with a maximum length of 2 cm and less than 50% of the circumference RFA will be performed with the HALO-90 RFA device. It is expected that the minority of patients will require some form of additional RFA and that this mainly will be done using HALO-90 RFA device.
Follow-up
- T=6 months: endoscopy with either lugol staining or narrow band imaging with biopsies from neosquamous epithelium 4Q/2 cm, immediately below the neo-squamocolumnar junction (min. 4 Bx) and any residual/ recurrent Barrett's mucosa. Patients with sustaining Barrett's epithelium will be treated with ER. Followed by a follow-up endoscopy after 2 months.
- T=12 months: endoscopy with either lugol staining or narrow band imaging with biopsies from neosquamous epithelium 4Q/2 cm, immediately below the neo-squamocolumnar junction (min. 4 Bx) and any residual/ recurrent Barrett's mucosa.
- From the second year: annual endoscopy with either lugol staining or narrow band imaging with biopsies from neosquamous epithelium 4Q/2 cm, immediately below the neo-squamocolumnar junction (min. 4 Bx) and any residual/ recurrent Barrett's mucosa.
- Trial web siteN/A
- statusinclusion stopped: follow-up
- CONTACT FOR PUBLIC QUERIESProf. dr. J.J.G.H.M. Bergman
- CONTACT for SCIENTIFIC QUERIESProf. dr. J.J.G.H.M. Bergman
- Sponsor/Initiator Academic Medical Center (AMC), Department of Hepato- and Gastroenterology
- Funding
(Source(s) of Monetary or Material Support)
BRRX Medical Inc. Sunnyvale, California, US
- PublicationsN/A
- Brief summaryThe purpose of this project is to evaluate the combination of ER, circumferential RFA using the HALO-360 system, and focal RFA using the HALO-90 system for the treatment of Barrett's esophagus with HGD or early cancer. This will be a multi-centre European study including 10 tertiary referral centres for the endoscopic treatment of early Barrett's neoplasia. An arbitrary number of 10 patients per centre will be included.
- Main changes (audit trail)
- RECORD24-jan-2008 - 14-nov-2012


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