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Randomized Controlled Trial
. 2015 Aug;64(8):1192-9.
doi: 10.1136/gutjnl-2014-308501. Epub 2014 Dec 24.

Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry

R J Haidry  1 , M A Butt  2 , J M Dunn  3 , A Gupta  4 , G Lipman  2 , H L Smart  5 , P Bhandari  6 , L Smith  7 , R Willert  8 , G Fullarton  9 , M Di Pietro  10 , C Gordon  11 , I Penman  12 , H Barr  13 , P Patel  14 , N Kapoor  15 , J Hoare  16 , R Narayanasamy  17 , Y Ang  18 , A Veitch  19 , K Ragunath  20 , M Novelli  4 , L B Lovat  1 ; UK RFA Registry
Collaborators, Affiliations
Free PMC article
Randomized Controlled Trial

Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry

R J Haidry et al. Gut. 2015 Aug.
Free PMC article

Abstract

Background: Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.

Methods: We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated.

Results: 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).

Conclusions: Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients.

Trial registration number: ISRCTN93069556.

Keywords: BARRETT'S OESOPHAGUS; ENDOSCOPIC PROCEDURES; OESOPHAGEAL CANCER.

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Figures

Figure 1
Figure 1
UK radiofrequency ablation (RFA) registry protocol. The treatment protocol started following the first RFA treatment even in patients who had had prior RFA. BE, Barrett's oesophagus.
Figure 2
Figure 2
Graph showing improvement in complete reversal of intestinal metaplasia (CR-IM) and complete reversal of dysplasia (CR-D) in patients undergoing radiofrequency ablation/endoscopic mucosal resection between 2008–2010 and 2011–2013.
Figure 3
Figure 3
Kaplan–Meier analysis demonstrating estimated cancer progression from start of treatment in patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia over the two time periods.
Figure 4
Figure 4
Kaplan–Meier survival statistics showing durability of neoplasia reversal in patients treated within the two time periods.
Figure 5
Figure 5
Kaplan–Meier survival statistics showing durability of intestinal metaplasia reversal in patients treated within the two time periods.
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