PTU-045 Does age matter? endoscopic submucosal dissection (ESD) for early barrett's neoplasia. Issue 2 (June 2019)

• Record Type: Journal Article
• Authors: Arndtz, Sophie; Subramaniam, Sharmila; Hossain, Ejaz; Adbelrahim, Mohamed; Bhandari, Pradeep
• Is Part Of: Gut. Volume 68:Issue 2(2019)
• Page Start: A137
• Page End: A137
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.259
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Aims: ESD is an established therapeutic option for the management of early Barrett's neoplasia, offering superior en-bloc and R0 resection rates compared to endoscopic mucosal resection. However, ESD is thought to have a higher complication rate, due to the increased complexity of the procedure. The aim of our study was to evaluate the safety and efficacy of ESD for Barrett's neoplasia in an ageing Western population. Methods: We performed a retrospective analysis of all ESDs conducted for Barrett's neoplasia within a single tertiary referral centre in the UK from 2012–2018. Older patients were defined as ≥75 years of age and younger patients <75 years of age at time of procedure. Results: 146 of 316 Barrett's resections were ESDs, of which 51 were ≥75 years and 95 <75 years. Overall age range was 42–94 years and mean follow up was 3.5 years. Average Barrett's length was 5.5 cm with 16% of neoplasia occurring in short (<3 cm) segment Barrett's. Lesion characteristics were similar between the two groups, except increased scarring in ≥75 group (table 1 ). R0 resection rate was 70.6% in ≥75 group and 77.9% in <75 group, with only 3.9% of ≥75 group and 5.3% of <75 group proceeding to surgery or chemoradiotherapy for residual or recurrent neoplasia. Complications occurred in 5.9% of ≥75 group (1 perforation, 2 bleeds) and 4.2% of <75 group (4 strictures), all of which were endoscopically managed. 3.9% of ≥75 group and 15.8% of <75 group proceeded to surgery following poor prognostic histology and overall 80.8% of all patients continued with sole endoscopic management. Conclusion: ESD is safe and effective in all ages. No significant difference was seen in complication rates between age groups and all adverse events were endoscopically treatable with no long term sequelae. We feel that age should not be a barrier to the use of ESD for early Barrett's neoplasia.