Haidry, R;
Butt, MA;
Lipman, G;
(2015)
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.
Gut
, 64
(8)
pp. 1192-1199.
10.1136/gutjnl-2014-308501.
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Abstract
Background: Barrett’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) are alternatives to surgery for patients with Barrett’s related neoplasia. Methods: We examine prospective data from United Kingdom (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 reached. Outcomes for clearance of dysplasia (CR-D) & BE (CR-IM) at end of treatment were assessed over two time periods, between 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 have improved significantly between 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% versus 2.1%, p=0.51). Conclusion: 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.
| Type: | Article |
|---|---|
| Title: | 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 |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/gutjnl-2014-308501 |
| Publisher version: | http://dx.doi.org/10.1136/gutjnl-2014-308501 |
| Language: | English |
| Additional information: | This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Barrett’s oesophagus, Oesophageal cancer, Endoscopic therapy, Database analysis, Population study |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1458572 |
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