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GIE FOCUS ON. . . ORIGINAL ARTICLE Outcomes from a prospective trial of endoscopic radiofrequency ablation of early squamous cell neoplasia of the esophagus Jacques J.G.H.M. Bergman, MD, PhD, Yue-Ming Zhang, MD, Shun He, MD, Bas Weusten, MD, Liyan Xue, MD, David E. Fleischer, MD, Ning Lu, MD, Sanford M. Dawsey, MD, Gui-Qi Wang, MD Radiofrequency ablation (RFA) is safe and effective for eradicating neoplasia in Barrett’s esophagus. The authors’ objective was to evaluate RFA for eradicating early esophageal squamous cell neoplasia (ESCN) defined as moderate-grade squamous intraepithelial neoplasia (MGIN) and high-grade squamous intraepithelial neoplasia (HGIN) and early flat-type esophageal squamous cell carcinoma (ESCC). This was a prospective cohort study, which took place at a tertiary referral center. Esophageal unstained lesions (USLs) were identified using Lugol’s chromoendoscopy. Inclusion criteria were at least 1 flat (type 0-IIb) USL 3 cm or larger, USL-bearing esophagus 12 cm or less, and a consensus diagnosis of MGIN, HGIN, or ESCC by two expert GI pathologists. Exclusion criteria were previous endoscopic resection or ablation, stricture, or any non-flat mucosa. Twenty-nine patients (14 male, mean age 603 years) with MGIN (n ⫽ 18), HGIN (n ⫽ 10), or ESCC (n ⫽ 1) participated. The mean USL length was 6.2 cm (treatment area 8.2 cm). At 3 months after 1 RFA session, 86% of patients (25/29) had a CR. At 12 months, 97% of patients (28/29) had a CR. There was no neoplastic progression. There were 4 strictures, all dilated to resolution. The authors concluded that in patients with early ESCN (MGIN, HGIN, flat-type ESCC), RFA was associated with a high rate of histological complete response (97% of patients), no neoplastic progression, and an acceptable adverse event profile. Read this article on pages 1181-90 in this issue.
ORIGINAL ARTICLE A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding John R. Saltzman, MD, Ying P. Tabak, PhD, Brian H. Hyett, MD, Xiaowu Sun, PhD, Anne C. Travis, MD, MSc, Richard S. Johannes, MD, MPH Although the early use of a risk stratification score in upper GI bleeding is recommended, existing risk scores are not widely used in clinical practice. The authors sought to develop and validate an easily calculated bedside risk score by using data routinely available at initial evaluation. Data from patients admitted from the emergency department with acute upper GI bleeding were extracted from a database containing information from 187 U.S. hospitals. Recursive partitioning was applied to derive a risk score for in-hospital mortality by using data from 2004 to 2005 in 29,222 patients. The score was validated by using data from 2006 to 2007 in 32,504 patients. Accuracy to predict mortality was assessed by the area under the receiver operating characteristic (AUROC) curve. The 5 factors present at admission with the best discrimination were albumin less than 3.0 g/dL, international normalized ratio greater than 1.5, altered mental status, systolic blood pressure 90 mm Hg or lower, and age older than 65 years. For those with no risk factors, the mortality rate was 0.3%, compared with 31.8% in patients with all 5 (P ⬍ .001). The model had a high predictive accuracy (AUROC ⫽ 0.80; 95% CI, 0.78-0.81), which was confirmed in the validation cohort (AUROC ⫽ 0.77, 95% CI, 0.75-0.79). Longer lengths of stay and increased costs were seen with higher scores (P ⬍ .001). The authors concluded that AIMS65 is a simple, accurate risk score that predicts in-hospital mortality, length of stay, and cost in patients with acute upper GI bleeding. Read this article on pages 1215-24 in this issue.
14A GASTROINTESTINAL ENDOSCOPY Volume 74, No. 6 : 2011
www.giejournal.org
ORIGINAL ARTICLE A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding John R. Saltzman, MD, Ying P. Tabak, PhD, Brian H. Hyett, MD, Xiaowu Sun, PhD, Anne C. Travis, MD, MSc, Richard S. Johannes, MD, MPH Although the early use of a risk stratification score in upper GI bleeding is recommended, existing risk scores are not widely used in clinical practice. The authors sought to develop and validate an easily calculated bedside risk score by using data routinely available at initial evaluation. Data from patients admitted from the emergency department with acute upper GI bleeding were extracted from a database containing information from 187 U.S. hospitals. Recursive partitioning was applied to derive a risk score for in-hospital mortality by using data from 2004 to 2005 in 29,222 patients. The score was validated by using data from 2006 to 2007 in 32,504 patients. Accuracy to predict mortality was assessed by the area under the receiver operating characteristic (AUROC) curve. The 5 factors present at admission with the best discrimination were albumin less than 3.0 g/dL, international normalized ratio greater than 1.5, altered mental status, systolic blood pressure 90 mm Hg or lower, and age older than 65 years. For those with no risk factors, the mortality rate was 0.3%, compared with 31.8% in patients with all 5 (P ⬍ .001). The model had a high predictive accuracy (AUROC ⫽ 0.80; 95% CI, 0.78-0.81), which was confirmed in the validation cohort (AUROC ⫽ 0.77, 95% CI, 0.75-0.79). Longer lengths of stay and increased costs were seen with higher scores (P ⬍ .001). The authors concluded that AIMS65 is a simple, accurate risk score that predicts in-hospital mortality, length of stay, and cost in patients with acute upper GI bleeding. Read this article on pages 1215-24 in this issue.
14A GASTROINTESTINAL ENDOSCOPY Volume 74, No. 6 : 2011
www.giejournal.org