Introduction The current standard of treating Barrett’s neoplasia is resection of visible lesions followed by ablative therapy to the Barrett’s segment. Endoscopic mucosal resection (EMR) is the conventional method of resection although there is growing evidence for the use of endoscopic submucosal dissection (ESD). Radiofrequency ablation (RFA) is a safe and effective ablation technique but carries a risk of complications including bleeding, stricture and perforation. ESD is associated with much deeper submucosal dissection then EMR, resulting in a deeper and thicker scar. This has been a cause for concern whilst performing RFA after ESD and experts have raised the possibility of higher stricture or perforation rates with RFA after ESD. We wish to compare the safety and efficacy of radiofrequency ablation following EMR and ESD and to ascertain if there are any significant differences.
Methods An electronic database (from 2007–2015) of all patients who had endoscopic resections (EMR or ESD) for Barrett’s neoplasia followed by RFA was analysed. Data was collected on patient demographics, Barrett’s length, lesion size, number of ablations required and follow up period. The clearance of neoplasia (high grade dysplasia/intramucosal cancer) was also recorded (CE-N) along with procedural complications including bleeding, perforation and strictures.
Results There were 30 patients in the EMR + RFA group (average age 73.1 years) compared to 19 in the ESD + RFA group (average age 74.6 years).
Patients received circumferential ablation (HALO 360) or focal ablation (HALO 90/60/Ultra) depending on the extent of residual Barrett’s oesophagus post endoscopic resection. The table below shows the outcome of RFA following EMR or ESD. ESD was started in our institution later than EMR and that is reflected in lower numbers and shorter follow up in the ESD cohort but it is otherwise a well matched population.
Conclusion This is the first UK series reporting on the safety and efficacy of RFA after ESD.
RFA following ESD or EMR is equally safe and effective and the endoscopic resection method is not a significant factor when planning ablation therapy.
Disclosure of Interest None Declared