Introduction The standard protocol for radiofrequency ablation (RFA) of Barrett’s oesophagus (BO) entails two treatment phases separated by cleaning of mucosal slough. A simplified protocol without the cleaning phase allows reduction of the procedure duration and number of intubations. The simplified protocol was proven to be non-inferior to the standard protocols in single application studies, but there is lack of data relative to the overall treatment pathway. The aim of this study was to compare overall safety and efficacy of the two protocols in two cohorts of patients treated with standard or simplified protocols.
Method We collected data on 143 patients receiving RFA for dysplastic BO between December 2007 and October 2016 at a single institution. Until November 2012 all patients received the standard RFA protocol, which was thereafter substituted with the simplified one. In the standard protocol circumferential RFA consisted of two hits at 12 J/cm2 separated by cleaning phase and focal RFA consisted of double hit 15 J/cm2, cleaning and double hit at 15 J/cm2. In the simplified protocol circumferential RFA consisted of double hit at 12 J/cm2 without cleaning, while focal RFA consisted of triple hit at 12 J/cm2 without cleaning. Patients treated with a mixture of the two protocols were excluded. Outcomes included complete remission of dysplasia (CR-D), complete remission of intestinal metaplasia (CR-IM) and complication rate. Patient still receiving treatment after 18 months from the first RFA were regarded as failure.
Results After exclusion of patient still on active treatment and those who received RFA with a mixture of the two protocols, 46 patients were included in the standard protocol and 50 patients in the simplified one. There was no difference between the two groups in terms of sex, length of the BO and size of the hiatus hernia. Patients in the standard group were significantly older (72.2 vs 67.4, p=0.02) and had significantly higher proportion of intramucosal cancer and lower proportion of low-grade dysplasia (LGD) (p=0.001) due to recent approval of RFA for LGD. The rates of CR-D and CR-IM with the standard protocol were 91% and 82%, respectively, and with the simplified protocol 100% and 88%, respectively, which was not significantly different. Stricture rate was significantly higher in the simplified group (9/50 vs 1/46, p=0.016), with a median number of dilations of 1 in each group.
Conclusion In this cohort study assessing overall outcomes, the standard and simplified protocol were equally effective, but the simplified carried a higher risk of stricture, which could be easily managed endoscopically with a single dilatation in most cases.
Disclosure of Interest None Declared
- Barretts Oesophagus
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