Introduction Radiofrequency ablation (RFA) is widely accepted as the treatment of choice for dysplastic Barrett’s oesophagus (BO) without visible lesions. Currently a new simplified protocol reduces repeated intubation for the treatment of Barrett’s oesophagus (BO). We aimed to evaluate the safety and efficacy of the simplified protocol compared to the standard one.
Method We analysed data retrospectively from a prospectively collected Barrett’s database from a single tertiary referral UK Centre. All consecutive patients who underwent RFA treatment for Barrett’s dysplasia from 1st of June 2012 to 31st of October 2016 were included. The new simplified protocol was adopted in our unit from October 2014. The simplified protocol omits cleaning in between ablations, reduces the total number of ablations (2 for the circumferential device and 3 for the focal devices vs. 4 ablations) and the amount of energy delivered (10J vs. 12 J for circumferential device and 12J vs. 15J for focal devices). Hospital records were reviewed and demographics, type of RFA device, RFA protocol, endoscopic resection (ER) prior/during RFA and post-RFA complications were collected. Patients who had received both the standard and the simplified protocols were excluded from the analysis.
Results A total of 97 patients (82.4% male; mean age 67.2±9.2 years, median Barrett’s length C4M6) received at least one RFA session. ER of visible lesions was performed in 32 patients (32.9%) prior to RFA and in 32 patients (32.9%) during the RFA treatment. The standard protocol was used in 30 patients for a total of 89 sessions (16 circumferential, 73 focal) and the simplified protocol in 67 patients for 154 sessions (45 circumferential, 109 focal).5 patients developed symptomatic strictures requiring dilatation. All 5 patients had been treated with simplified protocol (4 circumferential and 1 focal).Other complications included chest pain (n=3) and fever (n=2) managed conservatively, mild bleeding (n=3) successfully managed endoscopically and one severe bleeding which required blood transfusion. No perforations occurred. Complete remission of any dysplasia (CR-DYS) was achieved in 28/29 patients (96.5%) and complete remission of intestinal metaplasia (CR-IM) in 25/29 patients (86.2%) in the standard protocol group. CR-DYS was achieved in 36/38patients (94.7%) and CR-IM in 33/38 patients (86.8%) in the simplified group. The median follow up was 24 months for the standard protocol and 7 months for the simplified protocol.
Conclusion The efficacy of the simplified RFA protocol is comparable to the standard one. However, the simplified RFA protocol resulted in a higher stricture rate compared to the standard one, with higher risk for circumferential than focal treatment.
Disclosure of Interest None Declared
- Barrett’s Oesophagus
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