533. OUTCOMES OF RADIOFREQUENCY ABLATION TO TREAT BARRETT'S OESOPHAGUS: AN IRISH MULTICENTRE STUDY. (24th September 2022)

• Record Type: Journal Article
• Authors: Kyle, Eimear; Donohoe, Claire
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.533
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: The standard two-step approach of endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) has shown to be both safe and effective in achieving complete eradication of intestinal metaplasia (CEIM). Despite confidence in the regimen, the long-term sustainability of CEIM has not been well-described, nor has the ideal number of RFA sessions and frequency and length of surveillance. This study used the RIBBON database in Ireland to analyse these factors. Analysis was performed on 398 eligible patients who underwent at least one session of RFA to treat BE from 2009 to 2021 in major centres across Ireland. Patients included had a minimum of 12 months follow-up (FU), with a total 1433.76 patient-years of FU analysed. CEIM was defined as histological and endoscopic absence of BE at post-RFA FU. Patient outcomes were categorised according to recurrence status at FU: sustained CEIM, primary recurrence, treatment failure and unknown outcomes. They were also grouped according to the extent of dysplasia using the Vienna Grading System. Of the 398 patients, 78.14% were male, the mean age at diagnosis was 61.55 years, mean length of Barrett's segment was 5.36cm, and baseline dysplasia was 19.3% intramucosal carcinoma (IMC), 19% high-grade dysplasia (HGD), 23.3% low-grade dysplasia (LGD) and 37.1% non-dysplastic BE (NBDE). Of these patients, 321 (80.65%) achieved CEIM, at similar proportions. Of those, 67 (20.87%) experienced recurrence over 404.97 patient-years of FU. Further recurrence following subsequent treatment was rare (6 cases). The most common type of recurrence was NDBE (95.64%), and dysplastic recurrence was uncommon (4.36%). The mean time to recurrence was 647.21 days. The results of this study showed that CEIM was achieved by RFA in the majority of cases, with dysplastic recurrence occurring at a very low rate, equating to significantly reduced disease progression. There was a significant difference between the mean number of treatments for those who achieved sustained CEIM (4.15) and those who experienced recurrence (3.29). It is clear that some adjustments to the existing treatment and surveillance regimen could result in improvements in outcome.