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Endoscopy. 2015 Nov;47(11):980-7. doi: 10.1055/s-0034-1392414. Epub 2015 Jun 30.

Comparing outcome of radiofrequency ablation in Barrett's with high grade dysplasia and intramucosal carcinoma: a prospective multicenter UK registry.

Author information

1
Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
2
Department of Gastroenterology, Guy's & St Thomas' NHS foundation Trust, London, United Kingdom.
3
Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
4
Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
5
Solent Centre for Digestive Diseases, Princess Alexandra Hospital, Portsmouth, United Kingdom.
6
Department of Gastroenterology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
7
Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
8
Department of Gastroenterology, Addenbrookes Hospital, Cambridge, United Kingdom.
9
Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
10
Department of Gastroenterology, Royal Infirmary Edinburgh, Edinburgh, United Kingdom.
11
Department of Gastroenterology, Gloucestershire Hospital NHS Trust, Gloucester, United Kingdom.
12
Department of Gastroenterology, Southampton University Hospital, Southampton, United Kingdom.
13
Gastrointestinal Unit, Aintree University Hospital, Liverpool, United Kingdom.
14
Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
15
Department of Gastroenterology, St Mary's Hospital NHS Trust, London, United Kingdom.
16
Department of Gastroenterology, St James Hospital, Dublin, Ireland.
17
Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
18
Department of Gastroenterology, Frimley Park Hospital NHS foundation Trust, Frimley, United Kingdom.
19
Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Manchester, United Kingdom.
20
Endoscopy and Bowel Cancer Screening, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom.
21
Department of Gastroenterology, County Durham Hospital, Durham, United Kingdom.
22
Department of Gastroenterology, Newcastle-upon-Tyne Hospital, Newcastle-upon-Thyne, United Kingdom.
23
Wolfson Digestive Diseases Centre, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.
24
Department of Gastroenterology, Watford Hospital, Watford, United Kingdom.

Abstract

BACKGROUND AND STUDY AIM:

Mucosal neoplasia arising in Barrett's esophagus can be successfully treated with endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA). The aim of the study was to compare clinical outcomes of patients with high grade dysplasia (HGD) or intramucosal cancer (IMC) at baseline from the United Kingdom RFA registry.

PATIENTS AND METHODS:

Prior to RFA, visible lesions and nodularity were removed entirely by EMR. Thereafter, patients underwent RFA every 3 months until all visible Barrett's mucosa was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points were reached.

RESULTS:

A total of 515 patients, 384 with HGD and 131 with IMC, completed treatment. Prior to RFA, EMR was performed for visible lesions more frequently in the IMC cohort than in HGD patients (77 % vs. 47 %; P < 0.0001). The 12-month complete response for dysplasia and intestinal metaplasia were almost identical in the two cohorts (HGD 88 % and 76 %, respectively; IMC 87 % and 75 %, respectively; P = 0.7). Progression to invasive cancer was not significantly different at 12 months (HGD 1.8 %, IMC 3.8 %; P = 0.19). A trend towards slightly worse medium-term durability may be emerging in IMC patients (P = 0.08). In IMC, EMR followed by RFA was definitely associated with superior durability compared with RFA alone (P = 0.01).

CONCLUSION:

The Registry reports on endoscopic therapy for Barrett's neoplasia, representing real-life outcomes. Patients with IMC were more likely to have visible lesions requiring initial EMR than those with HGD, and may carry a higher risk of cancer progression in the medium term. The data consolidate the approach to ensuring that these patients undergo thorough endoscopic work-up, including EMR prior to RFA when necessary.

PMID:
26126159
DOI:
10.1055/s-0034-1392414
[Indexed for MEDLINE]

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