Introduction EMR and Radio Frequency Ablation (RFA) have recently been combined to treat dysplastic Barrett’s oesophagus (1). These are complex techniques and require a high level of endoscopic skill and published reports show a range of success. The Academic Medical Centre (AMC) in Amsterdam is a high volume tertiary centre for these procedures and has established expertise in providing structured teaching (2). After attending a structured teaching programme at the AMC a service was established at a London teaching hospital to treat patients with dysplastic Barrett’s oesophagus. We wanted to know if high quality results could be reproduced in this setting.
Methods We retrospectively analysed all cases of dysplastic Barrett’s referred for treatment at our centre since the introduction of RFA (Barryx), following structured training at the AMC. Decision for endoscopic therapy was made at a multidisciplinary meeting involving surgeons, radiologists, oncologists and gastroenterologists. Published protocols for treatment with EMR/RFA were closely followed (1), although argon plasma coagulation was used to remove residual islands less than 5mm in the interests of cost, rather than RFA. All procedures were carried out by one of two senior endoscopists.
Results Over 30 months 33 patients were referred for endoscopic therapy. Following initial EMR of visible lesions 3were found to have cancer extending beyond the first 1/3 of the sub-mucosa and were offered alternative therapy. 24have finished therapy and 1 is lost to follow up. Mean age was 70 years (53–89) and mean Barrett’s length 5.4cm (<1–10 cm). Therapy was applied as follows: 2 patients had only EMR, 4 only RFA, 1 EMR + APC, 6 EMR + RFA, 5 RFA +APC, 6 EMR + RFA + APC. 24/24 have had eradication of high grade dysplasia or intra-mucosal cancer (100%). 21/24(87.5%) have had complete eradication of Barrett’s by endoscopic and histological criteria. Mean follow up is 9.8 months(1.5–25). There were no perforations. 3 strictures were treated endoscopically.
Conclusion Following a comprehensive structured teaching programme in the treatment of dysplastic Barrett’s with combined RFA and EMR, results comparable to published studies are achievable in lower volume centres treating approximately only one new patient per month.
Disclosure of Interest None Declared
Radiofrequency ablation for total Barrett’s eradication: a description of the endoscopic technique, itsclinical results and future prospects. Pouw RE et al. Endoscopy. 2008 Dec; 40(12):1033–402.
Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications evenwithin a structured training programme. Van Vilsteren FG et al. Endoscopy. 2012 Jan; 44(1):4–12.
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