Journal 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

Gordon, C, Ang, Y, Haidry, R J, Gupta, A, Penman, I, Dunn, J M, Butt, M A, Barr, H, Hoare, J, Fullarton, G, Smart, H L, Kapoor, N, Bhandari, P, Di Pietro, M, Willert, R, Veitch, A, Novelli, M, Lovat, L B, Narayanasamy, R, Lipman, G, Smith, L, Ragunath, K, Patel, P

2015

Overview

BackgroundBarrett'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.MethodsWe 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.Results508 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).ConclusionsClinical 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 numberISRCTN93069556.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adenocarcinoma - pathology / Adenocarcinoma - surgery / Adult / Aged / Aged, 80 and over / Barrett Esophagus - surgery / Cancer / Catheter Ablation - methods / Clinical outcomes / Disease Progression / Endoscopy / Esophageal Neoplasms - pathology / Esophageal Neoplasms - surgery / Esophagoscopy - methods / Female / Follow-Up Studies / Gastroenterology / Hospitals / Humans / Male / Medical prognosis / Middle Aged / Mortality / Oesophagus / Patients / Precancerous Conditions / Prospective Studies / Registries / Surgery / Surveillance / Time Factors / Treatment Outcome / United Kingdom