You are here

  • Home
  • Archive
  • Volume 64, Issue 8
  • Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry

Article Text

Article menu

Download PDFPDF

XML
Oesophagus
Original article
Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry
  1. R J Haidry1,2,
  2. M A Butt1,
  3. J M Dunn3,4,
  4. A Gupta2,
  5. G Lipman1,
  6. H L Smart5,
  7. P Bhandari6,
  8. L Smith7,
  9. R Willert8,
  10. G Fullarton9,
  11. M Di Pietro10,
  12. C Gordon11,
  13. I Penman12,
  14. H Barr13,
  15. P Patel14,
  16. N Kapoor15,
  17. J Hoare16,
  18. R Narayanasamy17,
  19. Y Ang18,
  20. A Veitch19,
  21. K Ragunath20,
  22. M Novelli2,
  23. L B Lovat1,2
  24. on behalf of the UK RFA Registry
    1. 1Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
    2. 2Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
    3. 3Guy's and St Thomas’ NHS foundation Trust, London, UK
    4. 4Institute for Cancer Genetics and Informatics, Oslo University, Oslo, Norway
    5. 5Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK
    6. 6Princess Alexandra Hospital, Portsmouth, UK
    7. 7Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
    8. 8Central Manchester University Hospitals NHS Foundation Trust, Manchester,UK
    9. 9Glasgow Royal Infirmary, Glasgow, UK
    10. 10Addenbrooke's Hospital, Cambridge, UK
    11. 11Royal Bournemouth Hospital, Bournemouth, UK
    12. 12Royal Infirmary Edinburgh, Edinburgh, UK
    13. 13Oesophagogastric Surgery, Gloucestershire Hospital NHS Trust, Birmingham, UK
    14. 14Department of Gastroenterology, Southampton University Hospital, Southampton, UK
    15. 15Digestive Diseases Centre, Aintree University Hospital, Liverpool, UK
    16. 16St Mary's Hospital NHS Trust, London, UK
    17. 17St James Hospital, Dublin, Republic of Ireland
    18. 18Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, UK
    19. 19Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
    20. 20Department of Gastroenterology, Nottingham University Hospital NHS Trust, Nottingham, UK
    1. Correspondence to Dr Rehan Haidry, Department of Gastroenterology, UCLH, 235 Euston Road, London NW1 2BU, UK; r.haidry{at}ucl.ac.uk

    Abstract

    Background Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.

    Methods We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008–2010 and 2011–2013). Durability of successful treatment and progression to OAC were also evaluated.

    Results 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).

    Conclusions Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2–4% at 1 year in these high-risk patients.

    Trial registration number ISRCTN93069556.

    • BARRETT'S OESOPHAGUS
    • OESOPHAGEAL CANCER
    • ENDOSCOPIC PROCEDURES

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

    https://doi.org/10.1136/gutjnl-2014-308501

    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.

      View Full Text