Article Text

PDF
PWE-077 Residual Intestinal Metaplasia after Successful Endoscopic Therapy for Barrett’s Related Neoplasia Confers Higher Long Term Risk for Disease Recurrence, on Behalf of The UK RFA Registry
  1. G Lipman1,2,
  2. A Gupta2,
  3. JM Dunn3,
  4. D Morris2,
  5. H Smart4,
  6. P Bhandari5,
  7. RP Willert6,
  8. G Fullarton7,
  9. AJ Morris7,
  10. M Di Pietro8,
  11. C Gordon9,
  12. I Penman10,
  13. H Barr11,
  14. P Patel12,
  15. P Boger12,
  16. N Kapoor13,
  17. BS Mahon14,
  18. J Hoare15,
  19. R Narayanasamy16,
  20. D O’Toole16,
  21. Y Ang17,
  22. A Veitch18,
  23. D Nylander19,
  24. A Dhar20,
  25. K Ragunath21,
  26. A Leahy22,
  27. M Fullard22,
  28. R Haidry1,2,
  29. LB Lovat1,2,
  30. on behalf of The UK RFA Registry
  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. 7Glasgow Royal Infirmary, Glasgow
  8. 8Addenbrookes Hospital, Cambridge
  9. 9Royal Bournemouth Hospital, Bournemouth
  10. 10Royal Infirmary Edinburgh, Edinburgh
  11. 11Gloucestershire Hospital NHS Trust, Gloucestershire
  12. 12Southampton University Hospital, Southampton
  13. 13Aintree University Hospital, Liverpool
  14. 14Queen Elizabeth Hospital, Birmingham
  15. 15St Mary’s Hospital, London, UK
  16. 16St James Hospital, Dublin, Ireland
  17. 17Salford Royal Foundation NHS Trust, Manchester
  18. 18Wolverhampton NHS Trust, Wolverhampton
  19. 19Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
  20. 20County Durham Hospital, County Durham
  21. 21Nottingham University Hospital NHS Trust, Nottingham
  22. 22West Hertfordshire Hospitals NHS Trust, Watford, UK

Abstract

Introduction Endoscopic resection (ER) followed by Radiofrequency ablation (RFA) is the first line treatment for neoplastic Barrett’s oesophagus (BE). Metachronous neoplasia after focal eradication of disease is ~20%. We examine data from the UK registry of 28 centres to establish if residual metaplastic BE carries a risk of disease recurrence.

Methods Visible lesions were removed by EMR. Patients then underwent RFA 3 monthly. Biopsies were taken at 12 months to assess treatment success with repeat biopsies every 6–12 months thereafter. Dysplasia recurrence was compared in patients who had complete reversal of BE and neoplasia (CR-IM) to those in whom dysplasia alone was eradicated (CR-D only). Residual BE was confirmed with visible columnar epithelium proximal to the OGJ with biopsies showing IM.

Results 517 patients achieved CR-IM & 96 patients achieved CR-D only after 12 months treatment . Sex & ER rates were not significantly different between groups. The CR-D only group were older (mean age 70 vs 67, p < 0.01) and had longer initial BE (mean length 6.2 cm vs 4.7 cm, p < 0.0001). Mean residual BE length was 1.4 cm. At median follow up 32 months, more patients were disease free in the CR-IM group (96% vs 89%) and Kaplan Meier statistics demonstrated an improved predicted 6 year neoplasia free survival in the CR-IM group (90% vs 84% log rank p 0.0015). Most recurrences occurred within 3 years of follow up.

Conclusion Endotherapy should aim to clear neoplasia and underlying metaplastic BE to improve long term outcome. Patients with CR-D but not CR-IM at the end of treatment have an increased risk of neoplasia recurrence. This may have implications for post treatment surveillance intervals.

Disclosure of Interest None Declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.