{"title":"射频消融治疗高危胃肠化生的疗效：一项随机、自我控制研究。","authors":"Rapat Pittayanon, Kasenee Tiankanon, Natee Faknak, Nathawadee Lerttanatum, Anapat Sanpavat, Naruemon Klaikaew, Rungsun Rerknimitr","doi":"10.1111/jgh.16875","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Guidelines recommend endoscopic surveillance for gastric cancer without therapeutic intervention every 3 years in patients with high-risk gastric intestinal metaplasia (GIM). This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in eradicating high-risk GIM.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This randomized self-control trial was conducted between June 2020 and February 2023. Patients with histology-verified high-risk GIM were enrolled. The endoscopist performed a biopsy on both the left and right sides of the stomach (five each) by targeting the suspected GIM area where available; otherwise, a random biopsy was taken. Patients were randomized to receive a unilateral RFA on either the left or right side. A repeated RFA on the assigned side was performed every 2–3 months for a total of two to three times. The primary outcome was complete resolution of GIM at 1 year after RFA.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Forty-six patients with a mean age of 66 ± 8 years were analyzed. The complete resolution rate of overall GIM lesions after RFA was significantly higher (49/142; 34/5%) than that in the observation group (29/127; 22.8%, RR = 0.84, 0.73–0.98, <i>p</i> = 0.03). For the subgroup analysis, the complete resolution rate after RFA revealed a significantly higher value than observation only in the incomplete GIM group (24/87; 27.6% vs. 11/82; 13.4%, RR = 0.83, 0.71–0.97, <i>p</i> = 0.02). The percentage of patients with extensive GIM regression after RFA (15/25; 60%) was higher than in the observation group (9/25; 36%) but did not meet statistical significance (RR = 0.62, 0.35–1.09, <i>p</i> = 0.09).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>In high-risk GIM, RFA can significantly eradicate incomplete GIM when compared with observation alone.</p>\n </section>\n </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 4","pages":"891-899"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Radiofrequency Ablation as a Treatment for High-Risk Gastric Intestinal Metaplasia: A Randomized, Self-Control Study\",\"authors\":\"Rapat Pittayanon, Kasenee Tiankanon, Natee Faknak, Nathawadee Lerttanatum, Anapat Sanpavat, Naruemon Klaikaew, Rungsun Rerknimitr\",\"doi\":\"10.1111/jgh.16875\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Guidelines recommend endoscopic surveillance for gastric cancer without therapeutic intervention every 3 years in patients with high-risk gastric intestinal metaplasia (GIM). This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in eradicating high-risk GIM.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This randomized self-control trial was conducted between June 2020 and February 2023. Patients with histology-verified high-risk GIM were enrolled. The endoscopist performed a biopsy on both the left and right sides of the stomach (five each) by targeting the suspected GIM area where available; otherwise, a random biopsy was taken. Patients were randomized to receive a unilateral RFA on either the left or right side. A repeated RFA on the assigned side was performed every 2–3 months for a total of two to three times. The primary outcome was complete resolution of GIM at 1 year after RFA.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Forty-six patients with a mean age of 66 ± 8 years were analyzed. The complete resolution rate of overall GIM lesions after RFA was significantly higher (49/142; 34/5%) than that in the observation group (29/127; 22.8%, RR = 0.84, 0.73–0.98, <i>p</i> = 0.03). For the subgroup analysis, the complete resolution rate after RFA revealed a significantly higher value than observation only in the incomplete GIM group (24/87; 27.6% vs. 11/82; 13.4%, RR = 0.83, 0.71–0.97, <i>p</i> = 0.02). The percentage of patients with extensive GIM regression after RFA (15/25; 60%) was higher than in the observation group (9/25; 36%) but did not meet statistical significance (RR = 0.62, 0.35–1.09, <i>p</i> = 0.09).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>In high-risk GIM, RFA can significantly eradicate incomplete GIM when compared with observation alone.</p>\\n </section>\\n </div>\",\"PeriodicalId\":15877,\"journal\":{\"name\":\"Journal of Gastroenterology and Hepatology\",\"volume\":\"40 4\",\"pages\":\"891-899\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-01-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Gastroenterology and Hepatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jgh.16875\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jgh.16875","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：指南推荐高危胃肠道化生（GIM）患者每3年进行无治疗干预的内镜下胃癌监测。本研究旨在评估射频消融（RFA）在根除高危GIM中的疗效。方法：该随机自我控制试验于2020年6月至2023年2月进行。组织学证实的高风险GIM患者入组。内窥镜医师在胃的左右两侧（各5个）进行活组织检查，目标是可能的GIM区域；否则，进行随机活检。患者随机接受左侧或右侧单侧RFA。每2-3个月在指定一侧重复射频消融，共2-3次。主要终点为RFA后1年GIM完全消退。结果：本组患者46例，平均年龄66±8岁。RFA后GIM整体病变完全消退率显著高于RFA (49/142；34/5%)高于观察组(29/127；22.8%, RR = 0.84, 0.73-0.98, p = 0.03)。在亚组分析中，RFA后的完全解析率明显高于仅观察不完全GIM组(24/87；27.6% vs. 11/82；13.4%, RR = 0.83, 0.71 ~ 0.97, p = 0.02)。RFA后广泛GIM消退的患者百分比(15/25；60%)高于观察组(9/25；36%)，但无统计学意义（RR = 0.62, 0.35-1.09, p = 0.09）。结论：与单纯观察相比，RFA治疗高危GIM能显著根除不完全性GIM。
Efficacy of Radiofrequency Ablation as a Treatment for High-Risk Gastric Intestinal Metaplasia: A Randomized, Self-Control Study
Background
Guidelines recommend endoscopic surveillance for gastric cancer without therapeutic intervention every 3 years in patients with high-risk gastric intestinal metaplasia (GIM). This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in eradicating high-risk GIM.
Methods
This randomized self-control trial was conducted between June 2020 and February 2023. Patients with histology-verified high-risk GIM were enrolled. The endoscopist performed a biopsy on both the left and right sides of the stomach (five each) by targeting the suspected GIM area where available; otherwise, a random biopsy was taken. Patients were randomized to receive a unilateral RFA on either the left or right side. A repeated RFA on the assigned side was performed every 2–3 months for a total of two to three times. The primary outcome was complete resolution of GIM at 1 year after RFA.
Results
Forty-six patients with a mean age of 66 ± 8 years were analyzed. The complete resolution rate of overall GIM lesions after RFA was significantly higher (49/142; 34/5%) than that in the observation group (29/127; 22.8%, RR = 0.84, 0.73–0.98, p = 0.03). For the subgroup analysis, the complete resolution rate after RFA revealed a significantly higher value than observation only in the incomplete GIM group (24/87; 27.6% vs. 11/82; 13.4%, RR = 0.83, 0.71–0.97, p = 0.02). The percentage of patients with extensive GIM regression after RFA (15/25; 60%) was higher than in the observation group (9/25; 36%) but did not meet statistical significance (RR = 0.62, 0.35–1.09, p = 0.09).
Conclusion
In high-risk GIM, RFA can significantly eradicate incomplete GIM when compared with observation alone.
期刊介绍：
Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.
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