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Minimally invasive endoscopic therapy for early oesophageal cancer

Haidry, RJ; (2016) Minimally invasive endoscopic therapy for early oesophageal cancer. Masters thesis , UCL (University College London). Green open access

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Abstract

Barrett’s oesophagus (BE) is the pre-cancerous lesion that leads to oesophageal adenocarcinoma (OAC). The progression from metaplasia to dysplasia in Barrett’s oesophagus occurs in only a few of these patients. However once high grade dysplasia (HGD) and intramucosal cancer (IMC) have developed these patients carry a significant risk of progression to OAC. The risk of patients with HGD in BE progressing to OAC is estimated to be between 16-59 % within five years of diagnosis. Despite medical advances in the past decade the survival from OAC is dismal, with less than 15% of all patients being alive in five years from diagnosis. If an intervention can be offered at the pre-cancerous stage of this disease process to stop progression with the subsequent poor survival rate, then this is very desirable. In patients with localised OAC or mucosal neoplasia that is potentially curable, surgery with oesophagectomy has been the mainstay of management. However oesophagectomy even in specialist high volume centres carries a significant mortality of 2% and postoperative morbidity of up to 47%. The introduction of minimally invasive endotherapy such as photodynamic therapy (PDT), radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) over the past decade has seen a paradigm shift in the management of HGD and IMC in patients with BE. In 2010 the UK National Institute of Clinical Excellence (NICE) published guidelines approving the use of EMR and RFA in HGD in Barrett’s oesophagus. In 2013 the British Society of Gastroenterology endorsed the use of minimally invasive endoscopic treatment for low risk neoplasia arising in patients with Barrett’s oeosphagus over surgery. This thesis and the chapters that follow will outline the progress made in the United Kingdom embracing the change in practice for the management of these patients. It will demonstrate how innovations in endoscopic imaging and minimally invasive endoscopic therapies, such as endoscopic resection and radiofrequency ablation have now, through the formation and evolution of the UK RFA registry, become the standard of care in this country for the treatment of patients with BE related neoplasia. The thesis will outline the creation of the UK RFA patient registry, the construction of the registry database, processes of data collection, and then finally describe the methodology and analysis that has been used over the past five years. The chapters in this thesis report short and long term efficacy data from several large volume studies from the UK national registry, to test the hypothesis that patients with early oesophageal neoplasia can be successfully treated with minimally invasive endoscopic therapy.

Type: Thesis (Masters)
Title: Minimally invasive endoscopic therapy for early oesophageal cancer
Event: UNIVERSITY COLLEGE LONDON
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: This is a thesis submitted following examination and recommendation by examiners to make minor amendments.
Keywords: Oesophageal Cancer, Barrett's Oesophagus, Radiofrequency Ablation, Endoscopic resection
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
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/1477245
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