Browse by author
Lookup NU author(s): Dr David Nylander
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
Background: Barrett's oesophagus (BE) is a premalignant 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. Methods: We 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. Results: 508 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). Conclusions: Clinical 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 number ISRCTN93069556.
Author(s): Haidry RJ, Butt MA, Dunn JM, Gupta A, Lipman G, Smart HL, Bhandari P, Smith L, Willert R, Fullarton G, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Kapoor N, Hoare J, Narayanasamy R, Ang Y, Veitch A, Ragunath K, Novelli M, Lovat LB, Banks M, Sehgal V, Graham D, Sweis R, Miah H, Morris D, Boger P, Morris J, O'Toole D, Cheong E, Direkze N, Dhar A, Nylander D, Mahon B
Publication type: Article
Publication status: Published
Journal: Gut
Year: 2015
Volume: 64
Issue: 8
Pages: 1192-1199
Print publication date: 01/08/2015
Online publication date: 24/12/2014
Acceptance date: 29/11/2014
ISSN (print): 0017-5749
ISSN (electronic): 1468-3288
Publisher: BMJ Publishing Group
URL: http://doi.org/10.1136/gutjnl-2014-308501
DOI: 10.1136/gutjnl-2014-308501
PubMed id: 25539672
Altmetrics provided by Altmetric
