Introduction Endoscopic resection (ER) is a minimally invasive treatment for Barrett's high-grade dysplasia (HGD) and intramucosal cancer (IMC). However, a significant proportion of patients may develop malignant transformation of remaining Barrett's. Radiofrequency ablation (RFA) is a new, safe and effective modality for eradicating dysplasia and intestinal metaplasia. However there are limited data on the safety and efficacy of a combined approach including ER followed by RFA.
Methods The aim was to assess the feasibility, safety and efficacy of the combined approach. Patients were enrolled from two tertiary referral centres in UK, as part of a multicentre European trial (EURO II). All visible mucosal lesions were removed by ER. RFA was carried out at 6–8 weekly intervals for a maximum of five sessions. HALO 360 were used for circumferential ablation followed by HALO 90 for any remaining islands.
Results 20 patients (average age 63, 19 males) with a mean Barrett's length of 4.8 cm (range 2–11 cm) underwent ER of visible mucosal lesions. All patients had Paris 0-II lesions (IIa-14, IIb-5 and IIc-1) with a mean size of 12 mm (range 4–20 mm). ER was carried out using multiband mucosectomy device in 19 patients and ER cap in one patient. En-bloc resection was achieved in eight cases, the rest requiring a piecemeal approach. 10 (50%) patients were up-staged from HGD to IMC following ER. RFA was carried out at least 6 weeks after ER. After a median follow-up of 11 months (IQR 7.5–16.5) and a mean of 2.2 (range 1–5) RFA sessions, none of the patients had residual or recurrent dysplasia. On average, the combined approach resulted in 90% reduction in the endoscopically-observed extent of Barrett's mucosa. In eight patients who had completed the treatment regimen, complete histological resolution of intestinal metaplasia was achieved. Three patients (15%) developed minor procedure-related complications including 1 food bolus obstruction which was managed endoscopically, 1 superficial mucosal tear and 1 episode of self-limiting chest pain.
Conclusion Endoscopic resection followed by radiofrequency ablation is a feasible, safe and effective approach for eradicating dysplasia and intestinal metaplasia in Barrett's oesophagus. Long-term follow-up is warranted before this treatment modality could be implemented in routine clinical practice.
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