Gastroenterology

Gastroenterology

Volume 145, Issue 1, July 2013, Pages 87-95
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Radiofrequency Ablation and Endoscopic Mucosal Resection for Dysplastic Barrett's Esophagus and Early Esophageal Adenocarcinoma: Outcomes of the UK National Halo RFA Registry

https://doi.org/10.1053/j.gastro.2013.03.045Get rights and content

Background & Aims

Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early neoplasia increasingly receive endoscopic mucosal resection and radiofrequency ablation (RFA) therapy. We analyzed data from a UK registry that follows the outcomes of patients with BE who have undergone RFA for neoplasia.

Methods

We collected data on 335 patients with BE and neoplasia (72% with HGD, 24% with intramucosal cancer, 4% with low-grade dysplasia [mean age, 69 years; 81% male]), treated at 19 centers in the United Kingdom from July 2008 through August 2012. Mean length of BE segments was 5.8 cm (range, 1−20 cm). Patients' nodules were removed by endoscopic mucosal resection, and the patients then underwent RFA every 3 months until all areas of BE were ablated or cancer developed. Biopsies were collected 12 months after the first RFA; clearance of HGD, dysplasia, and BE were assessed.

Results

HGD was cleared from 86% of patients, all dysplasia from 81%, and BE from 62% at the 12-month time point, after a mean of 2.5 (range, 2−6) RFA procedures. Complete reversal dysplasia was 15% less likely for every 1-cm increment in BE length (odds ratio = 1.156; SE = 0.048; 95% confidence interval: 1.07−1.26; P < .001). Endoscopic mucosal resection before RFA did not provide any benefit. Invasive cancer developed in 10 patients (3%) by the 12-month time point and disease had progressed in 17 patients (5.1%) after a median follow-up time of 19 months. Symptomatic strictures developed in 9% of patients and were treated by endoscopic dilatation. Nineteen months after therapy began, 94% of patients remained clear of dysplasia.

Conclusions

We analyzed data from a large series of patients in the United Kingdom who underwent RFA for BE-related neoplasia and found that by 12 months after treatment, dysplasia was cleared from 81%. Shorter segments of BE respond better to RFA; http://www.controlled-trials.com, number ISRCTN93069556.

Section snippets

Inclusion Criteria

All patients were referred for consideration of ablative management of dysplastic BE at a collaborating center. Only males and nonpregnant females older than 21 years of age with no contraindications to endoscopy were considered. All patients gave written informed consent and agreed to attend at regular intervals for treatment and surveillance procedures. Ethical approval was granted by the Joint UCL/UCLH Committee on the Ethics of Human Research (REC REF 08/H0714/27).

Pre-Enrollment Staging

All patients were

Registry Enrollment and Demographics

We report the outcomes of 335 patients who have completed the 1-year protocol in the registry from 19 centers nationwide between July 2008 and August 2012.

Demographic data are shown in Table 1. The mean length of BE segment ablated was 5.8 cm (range, 0−20 cm). Before ablation, the highest grade lesion was HGD in 72% of patients. Two of the centers had previous experience in PDT and therefore 26 (8%) patients had ablation after residual neoplasia after PDT. Nearly half the patients in the cohort

Discussion

This is the largest series to date of patients with early Barrett's neoplasia undergoing RFA. These data demonstrate the diverse baseline characteristics of the patients and the success of integrating novel minimally invasive endotherapy into everyday practice from 19 centers nationwide.

There is ongoing debate about the role of minimally invasive endotherapy in the treatment of patients with BE. There have been great improvements in laparoscopic esophagectomy and data on long-term durability

Acknowledgments

This work was undertaken at UCLH/UCL, which received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health. The work was also supported by the CRUK UCL Early Cancer Medicine Centre.

References (27)

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Drs Lovat and Haidry had full access to all of the data and take full responsibility for the veracity of the data and statistical analysis.

Clinical Trials Registry: Ethical approval was granted by the Joint UCL/UCLH Committee on the ethics of Human research (REC REF 08/H0714/27).

Conflicts of interest This author discloses the following: L. B. Lovat has received grant support from BARRX Medical Inc and Covidien plc to support research infrastructure. Neither company has been involved in this research nor have they seen this manuscript before its submission. The remaining authors disclose no conflicts.

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