Rehan J Haidry1, Jason M Dunn1, Mohammed A Butt1, Matthew G Burnell2, Abhinav Gupta3, Sarah Green4, Haroon Miah4, Howard L Smart5, Pradeep Bhandari6, Lesley Ann Smith7, Robert Willert8, Grant Fullarton9, John Morris9, Massimo Di Pietro10, Charles Gordon11, Ian Penman12, Hugh Barr13, Praful Patel14, Philip Boger14, Neel Kapoor15, Brinder Mahon16, Jonathon Hoare17, Ravi Narayanasamy18, Dermot O'Toole18, Edward Cheong19, Natalie C Direkze20, Yeng Ang21, Marco Novelli3, Matthew R Banks3, Laurence Bruce Lovat22. 1. National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom. 2. Department of Biostatistics, University College London, London, United Kingdom. 3. GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom. 4. National Medical Laser Centre, University College London, London, United Kingdom. 5. Royal Liverpool University Hospital, Liverpool, United Kingdom. 6. Princess Alexandra Hospital, Portsmouth, United Kingdom. 7. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom. 8. Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom. 9. Glasgow Royal Infirmary, Glasgow, United Kingdom. 10. Addenbrookes Hospital, Cambridge, United Kingdom. 11. Royal Bournemouth Hospital, Bournemouth, United Kingdom. 12. Royal Infirmary Edinburgh, Edinburgh, United Kingdom. 13. Gloucestershire Hospital NHS Trust, Gloucestershire, United Kingdom. 14. Southampton University Hospital, Southampton, United Kingdom. 15. Aintree University Hospital, Liverpool, United Kingdom. 16. Queen Elizabeth Hospital, Birmingham, United Kingdom. 17. St Mary's Hospital NHS Trust, London, United Kingdom. 18. St James Hospital, Dublin. 19. Norfolk and Norwich University Hospital, Norwich, United Kingdom. 20. Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom. 21. Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, United Kingdom. 22. National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: l.lovat@uclh.nhs.uk.
Abstract
BACKGROUND & AIMS: Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early neoplasia increasingly receive endoscopic mucosal resection and radiofrequency ablation (RFA) therapy. We analyzed data from a UK registry that follows the outcomes of patients with BE who have undergone RFA for neoplasia. METHODS: We collected data on 335 patients with BE and neoplasia (72% with HGD, 24% with intramucosal cancer, 4% with low-grade dysplasia [mean age, 69 years; 81% male]), treated at 19 centers in the United Kingdom from July 2008 through August 2012. Mean length of BE segments was 5.8 cm (range, 1-20 cm). Patients' nodules were removed by endoscopic mucosal resection, and the patients then underwent RFA every 3 months until all areas of BE were ablated or cancer developed. Biopsies were collected 12 months after the first RFA; clearance of HGD, dysplasia, and BE were assessed. RESULTS: HGD was cleared from 86% of patients, all dysplasia from 81%, and BE from 62% at the 12-month time point, after a mean of 2.5 (range, 2-6) RFA procedures. Complete reversal dysplasia was 15% less likely for every 1-cm increment in BE length (odds ratio = 1.156; SE = 0.048; 95% confidence interval: 1.07-1.26; P < .001). Endoscopic mucosal resection before RFA did not provide any benefit. Invasive cancer developed in 10 patients (3%) by the 12-month time point and disease had progressed in 17 patients (5.1%) after a median follow-up time of 19 months. Symptomatic strictures developed in 9% of patients and were treated by endoscopic dilatation. Nineteen months after therapy began, 94% of patients remained clear of dysplasia. CONCLUSIONS: We analyzed data from a large series of patients in the United Kingdom who underwent RFA for BE-related neoplasia and found that by 12 months after treatment, dysplasia was cleared from 81%. Shorter segments of BE respond better to RFA; http://www.controlled-trials.com, number ISRCTN93069556.
BACKGROUND & AIMS:Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early neoplasia increasingly receive endoscopic mucosal resection and radiofrequency ablation (RFA) therapy. We analyzed data from a UK registry that follows the outcomes of patients with BE who have undergone RFA for neoplasia. METHODS: We collected data on 335 patients with BE and neoplasia (72% with HGD, 24% with intramucosal cancer, 4% with low-grade dysplasia [mean age, 69 years; 81% male]), treated at 19 centers in the United Kingdom from July 2008 through August 2012. Mean length of BE segments was 5.8 cm (range, 1-20 cm). Patients' nodules were removed by endoscopic mucosal resection, and the patients then underwent RFA every 3 months until all areas of BE were ablated or cancer developed. Biopsies were collected 12 months after the first RFA; clearance of HGD, dysplasia, and BE were assessed. RESULTS: HGD was cleared from 86% of patients, all dysplasia from 81%, and BE from 62% at the 12-month time point, after a mean of 2.5 (range, 2-6) RFA procedures. Complete reversal dysplasia was 15% less likely for every 1-cm increment in BE length (odds ratio = 1.156; SE = 0.048; 95% confidence interval: 1.07-1.26; P < .001). Endoscopic mucosal resection before RFA did not provide any benefit. Invasive cancer developed in 10 patients (3%) by the 12-month time point and disease had progressed in 17 patients (5.1%) after a median follow-up time of 19 months. Symptomatic strictures developed in 9% of patients and were treated by endoscopic dilatation. Nineteen months after therapy began, 94% of patients remained clear of dysplasia. CONCLUSIONS: We analyzed data from a large series of patients in the United Kingdom who underwent RFA for BE-related neoplasia and found that by 12 months after treatment, dysplasia was cleared from 81%. Shorter segments of BE respond better to RFA; http://www.controlled-trials.com, number ISRCTN93069556.
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