Endoscopic management of Barrett's dysplasia and early neoplasia: efficacy, safety and long-term outcomes in a UK tertiary centre. Issue Volume 33:Issue S1(2021) (12th March 2021)

• Record Type: Journal Article
• Authors: White, Jonathan Richard; Ortiz-Fernández-Sordo, Jacobo; Santiago-García, Jose; Reddiar, Dona; Learoyd, Anna; De Caestecker, John; Cole, Andrew; Kaye, Phillip; Ragunath, Krish
• Is Part Of: European journal of gastroenterology & hepatology. Volume 33:Issue S1(2021)
• Page Start: e413
• Page End: e422
• Publication Date: 2021-03-12
• Subjects: Barrett's esophagus -- dysplasia -- endoscopic mucosal resection -- esophageal cancer -- radiofrequency ablation; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000002121
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background and Objectives: Endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) are effective treatments for dysplastic Barrett's esophagus (BE). This study evaluates efficacy, durability and safety in a single high-volume UK tertiary centre with 15-years' experience. Methods: Prospective data were collected from Nottingham University Hospitals 2004–2019 for endotherapy of dysplastic BE or intramucosal adenocarcinoma. Procedural outcome measures include complete resection, complications and surgery rates. Efficacy outcomes include complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), recurrence, treatment failure rates, durability of RFA, median follow up and tumor-associated mortality. Results: A total of 319 lesions were resected; 671 RFAs were performed on 239 patients. Median age was 67 (±9.5) years, male:female ratio was 5:1 and median BE length was C3 [interquartile range (IQR): 6] M6 (IQR: 5). The most common lesion was Paris IIa (64%) with a median size of 10 mm (3–70). Final histology was adenocarcinoma in 50%. Complete resection rates were 96%. The multiband mucosectomy technique (91%) was most commonly used. The median number of RFA sessions was 3 (IQR: 2). The rates of CR-D and CR-IM were 90.4%% and 89.8% achieved after a median of 20.1 (IQR: 14) months. The most common complications: EMR was bleeding 2.2% and RFA was stricture (5.4%) requiring a median of 2 (range 1-7) dilatations. Median follow up post CR-IM/CR-D was 38 months (14–60). Metachronous lesions developed in 4.7% after CR-D and tumor-related mortality was 0.8%. Dysplasia and intestinal metaplasia-free survival at 5 years was 95 and 90%, respectively. Conclusion: BE endotherapy is minimally invasive, effective, safe and deliverable in a day-case setting.