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PWE-076 Specialist Centre Patient Volume Does Not Impact on Endoscopic Outcomes for Treatment of Barrett’s Dysplasia. Results from The UK Registry
  1. G Lipman1,2,
  2. A Gupta2,
  3. M Banks1,2,
  4. R Sweis2,
  5. JM Dunn3,
  6. D Morris2,
  7. H Smart4,
  8. P Bhandari5,
  9. RP Willert6,
  10. G Fullarton7,
  11. AJ Morris7,
  12. M Di Pietro8,
  13. P Mundre9,
  14. C Gordon10,
  15. I Penman11,
  16. H Barr12,
  17. P Patel13,
  18. P Boger13,
  19. N Kapoor14,
  20. BS Mahon15,
  21. J Hoare16,
  22. R Narayanasamy17,
  23. D O’Toole17,
  24. Y Ang18,
  25. A Veitch19,
  26. D Nylander20,
  27. A Dhar21,
  28. K Ragunath22,
  29. A Leahy23,
  30. M Fullard23,
  31. R Haidry1,2,
  32. LB Lovat1,2
  1. 1Division of Surgery & Interventional Science, University College London
  2. 2University College Hospital NHS Foundation Trust
  3. 3Guy’s and St Thomas’ NHS Foundation Trust, London
  4. 4Royal Liverpool University Hospital, Liverpool
  5. 5Queen Alexandra Hospital, Portsmouth
  6. 6Central Manchester University Hospitals NHS Foundation Trust, Manchester
  7. 7GRI, Glasgow
  8. 8Addenbrookes Hospital, Cambridge
  9. 9Bradford Royal Infirmary, Bradford
  10. 10Royal Bournemouth Hospital, Bournemouth
  11. 11Royal Infirmary Edinburgh, Edinburgh
  12. 12Gloucestershire Hospital NHS Trust, Gloucestershire
  13. 13Southampton University Hospital, Southampton
  14. 14Aintree University Hospital, Liverpool
  15. 15Queen Elizabeth Hospital, Birmingham
  16. 16St Mary’s Hospital, London, UK
  17. 17St James Hospital, Dublin, Ireland
  18. 18Salford Royal Foundation NHS Trust, Manchester
  19. 19Wolverhampton NHS Trust, Wolverhampton
  20. 20Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
  21. 21County Durham Hospital, County Durham
  22. 22Nottingham University Hospital NHS Trust, Nottingham
  23. 23West Hertfordshire Hospitals NHS Trust, Watford, UK

Abstract

Introduction Endoscopic mucosal resection (EMR) followed by Radiofrequency ablation (RFA) is first line treatment for mucosal Barrett’s oesophagus (BE) related neoplasia. The UK Registry collects data from patients at 28 sites undergoing RFA/EMR. We examine differences in outcomes between sites by patient volume.

Methods All visible lesions were entirely removed by EMR. Patients then underwent RFA every 3 months until all visible BE was ablated. Biopsies were taken at 12 months to assess treatment success with repeat biopsies every 6–12 months thereafter. Centres were grouped by total numbers treated; low <50, medium 50–100 & high >100 patients. Only outcomes of those who had completed treatment were analysed.

Results 675 patients completed treatment at 24 centres (median follow up 26 months), 414 at high volume (n = 5), 143 at medium volume (n = 4) & 118 at low volume centres (n = 15). There was no difference in entry criteria or demographics between groups. CR-D & CR-IM at 12 months are no different between the groups (CR-D 86–90%, CR-IM 74–81%). IM recurrence is significantly lower in high volume centres (16.1% vs 20.3% and 19.2%, Log Rank p < 0.001) but dysplasia recurrence is no different (Log Rank p = 0.12). Rescue EMR was performed less frequently in medium volume centres (0% vs high 5.3% and low volume 10%, p = 001).

Conclusion Endotherapy for Barrett’s dysplasia is highly effective whatever the centre volume. The rescue EMR rate in medium volume centres is unexplained. Despite lower IM recurrence in high volume centres, dysplasia recurrence rates are not significantly different. Caseload volume of a centre in the UK Registry does not appear to affect outcome.

Disclosure of Interest None Declared

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