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PTH-140 Dual modality endoscopic therapy for barrett’s-associated oesophageal dysplasia in a tertiary referral centre: completing the audit cycle
  1. M Almond1,
  2. C Florance2,
  3. O Old2,
  4. ZC Oliphant2,
  5. H Barr2
  1. 1West Midlands Deanery, Birmingham
  2. 2Gloucestershire Hospitals NHS Trust, Gloucester, UK

Abstract

Introduction The efficacy of dual modality endotherapy with endoscopic resection and mucosal ablation is now well documented in the treatment of Barrett’s-associated early neoplasia. This strategy was supported by a consensus survey of international experts in 2011 with the aim of achieving high rates of complete eradication of dysplasia and intestinal metaplasia (CE-D and CE-IM).1

This re-audit of clinical practice in a single tertiary oesophagogastric unit aimed to assess whether patients with Barrett’s-associated early neoplasia received dual modality endoscopic therapy in order to achieve CE-D and CE-IM.

Method In 2011 an audit standard was defined recommending that patients with early glandular neoplasia (high-grade dysplasia (HGD) +/- intramucosal cancer (IMC)) should receive dual modality endoscopic therapy aiming for CE-IM. In the initial audit phase a prospectively maintained database was interrogated between 2004–2011 in order to assess current practice. Changes in practice were implemented following in-house presentation to the oesophagogastric MDT in 2011, and practice and outcomes between 2012–2014 were re-audited.

Results The initial audit included 72 patients with a median follow-up of 38 months treated by ER +/- ablative therapy with curative intent for HGD (88%) or IMC (12%). The re-audit included 43 patients: LGD 2 (5%), HGD 31 (72%) and IMC 10 (23%), with a median follow-up was 21 months. The use of ablation therapy post-ER was higher in the re-audit group (86% vs 60%; p = 0.003). Rates of CE-D and CE-IM were also higher in the re-audit group (79% vs. 29%; p < 0.001) and (28% vs. 1%; p < 0.001) respectively. Disease progression to invasive cancer (at least T1b) appeared lower in the re-audit group although did not achieve statistical significance (2% Vs. 11%; p = 0.150).

Conclusion This completed audit cycle demonstrated that use of dual modality endoscopic therapy has increased since 2011. This was associated with higher CE-IM and CE-D rates. Regular audit and re-audit can improve outcomes in patients receiving endoscopic therapy for early Barrett’s-associated neoplasia.

Disclosure of interest None Declared.

Reference

  1. Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology. 2012;143(2):336–46

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