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• W2285569199 abstract "Patients Undergoing Radiofrequency Ablation (RFA) for Barrett’s Related Neoplasia Have Improved Outcomes With Decreasing Length’s of Baseline Barrett’s Eosophagus (BE) and Increasing Number of RFA Sessions Rehan J. Haidry*, Mohammed a. Butt, Abhinav Gupta, John R. Louis-Auguste, Jason M. Dunn, Howard Smart, Pradeep Bhandari, Lesley Ann Smith, Robert P. Willert, Grant Fullarton, Massimiliano Di Pietro, Charles Gordon, Ian D. Penman, Hugh Barr, Praful Patel, Philip C. Boger, Neil Kapoor, Brinder S. Mahon, Jonathan M. Hoare, Matthew Burnell, Ravi Narayanasamy, Dermot O’Toole, Edward Cheong, Natalie Direkze, Yeng S. Ang, Marco Novelli, Matthew R. Banks, Laurence Lovat Gastroenterology, University College Hospital, London, United Kingdom; National Medical Laser Centre, University of London, London, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Princess Alexandra Hospital, Portsmouth, United Kingdom; Central Manchester University Hospital, Manchester, United Kingdom; Glasgow Royal Infirmary, glasgow, United Kingdom; Adenbrookes Hospital, Cambridge, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Infirmary Edinburgh, edinburgh, United Kingdom; Gloucestershire Hospital NHS foundation Trust, Gloucester, United Kingdom; Southampton University Hospital, Southampton, United Kingdom; Aintree University Hospital, Liverpool, United Kingdom; Queen Elizabeth Hospital, Birmingham, United Kingdom; Department of Biostatistics, University of London, London, United Kingdom; St. Mary’s Hospital NHS trust, London, United Kingdom; St James Hospital, Dublin, Ireland; Norfolk and Norwich University Hospital, Norwich, United Kingdom; Frimley park Hospital NHS foundation Trust, London, United Kingdom; Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, London, United Kingdom; Guy’s and St Thomas’ Hospitals, London, United Kingdom; institute for Medical Infomatics, Oslo University Hospital, oslo, Norway; Bradford Teaching Hospitals, NHS foundation trust, Bradford, Bradford, United Kingdom Introduction: Barrett’s esophagus (BE) is the pre-cursor lesion to esophageal adenocarcinoma (EAC). High grade dysplasia (HGD) and early mucosal neoplasia arising in BE have a 40-60% risk of progressing to EAC. Survival from EAC is poor. Minimally invasive endotherapy with endoscopic mucosal resection (EMR) and RFA have emerged as alternatives to surgery for the curative treatment of patients with Barrett’s related neoplasia. Objective: Prospective data from the United Kingdom (UK) HALO RFA registry of patients undergoing RFA for early neoplasia arising in BE.Intervention: Before RFA, superficial lesions were removed by EMR. Patients then underwent RFA every 3 months until all visible BE was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points reached. If BE or dysplasia recurred, they were ablated at the endoscopist’s discretion. Outcomes: Primary outcomes were clearance for HGD (CR-HGD), all dysplasia (CR-D) & BE (CR-BE) at 12 months. Long term durability for CR-D for those with favorable outcomes at end of protocol was assessed. Predictors of successful outcomes were also examined. Results: 630 patients have consented to have their outcomes recorded. We report on 370 who have completed treatment protocol with 12 month histology. 81% are male, mean age 68 years (40-91). Patient’s underwent a mean of 2.5 ablations (1-6) during treatment protocol. 70% had baseline histology HGD, 27% IMC & 3% LGD. Mean length baseline BE was 5.6cm (1-20). At 12 months CR-HGD was 87% patients, CR-D 82%, & CR-BE 64%. 97% of those with no dysplasia at 12 months have remained free of disease at most recent follow up (median follow up 18 months, range 2-68). Kaplan Meier survival statistics predict CR-D is durable at 5 years with 88% remaining disease free. Logistic regression analysis to examine effect of baseline BE length on outcomes demonstrate that each extra 1 cm of BE reduces the chances of attaining CR D by 15.7% (OR 1.156, SE 0.048, CI 1.07 1.26, p 0.0003). Similarly using logistic regression, for each extra RFA treatment the likelihood of CR-D increases by 31.7% (OR 0.683, SE 0.95, CI 0.52 0.89, p 0.0006). Rate of progression to invasive cancer at 12 months was 2.7%. Symptomatic strictures requiring dilatation occurred in 9% of cases after treatment. Conclusion: This is the largest series to date of patients undergoing RFA from 19 UK centers. End of protocol CR-D is encouraging at 83% and successful eradication appears to be very durable. Patients with shorter segment BE are likely to respond better, and those who have multiple treatments are more likely to achieve CR-D. Our data represent real life outcomes of integrating minimally invasive endotherapy into demanding endoscopy service commitments. 284 Radiofrequency Ablation Combined With Endoscopic Mucosal Resection Is Safe and Effective in Eradicating Dysplastic Barrett’s Oesophagus: the Largest Reported Australian Experience With RFA Georgina Cameron*, Chatura Jayasekera, Richard a. Williams, Finlay a. Macrae, Paul Desmond, Andrew C. Taylor Gastroenterology Department, St Vincent’s Hospital, Melbourne, VIC, Australia; Gastroenterology Department, Royal Melbourne Hospital, Melbourne, VIC, Australia Introduction: Radiofrequency ablation (RFA) combined with endoscopic mucosal resection (EMR) for visible lesions is shown to be effective in eradicating dysplastic Barrett’s oesophagus (BE) providing a credible alternative to surgery for high grade dysplasia (HGD) and early mucosal cancer (IMC) in BE. This study aimed to assess efficacy and safety of RFA combined with EMR in patients with dysplastic BE treated at Melbourne’s two quaternary referral centres. This is the largest reported Australian cohort. Methods: Patients referred to St Vincent’s & Royal Melbourne Hospitals from 2008-September 2012 for endoscopic treatment of BE were entered prospectively into a central database. Patients underwent assessment endoscopy with white light, narrow band / confocal endomicroscopy and had EMR of any visible lesions. Subsequent staging investigations (endoscopic ultrasound/PET/CT), management and histological outcomes were recorded. Patients deemed appropriate for RFA (treatment group) were treated at 3 monthly intervals until remission of dysplasia (CR-D) and/or Barrett’s (CR-BE) was achieved. Patients underwent further EMR if visible lesions persisted. Remission rates were assessed for CR-D ( no dysplasia on biopsy) and CR-BE ( no intestinal metaplasia on biopsy and no macroscopic BE). Time to achieve remission and number of RFA treatments required to reach these endpoints were also recorded. Adverse events were defined as surgery, hospital admission, bleeding requiring blood transfusion or unplanned endoscopic intervention. Results: 164 patients were referred. 35 were assessed not suitable for combined endoscopic therapy (CET) due to advanced disease (24), nondysplastic BE (8) or comorbidities (3). 6 await assessment. Of 123 amenable to CET, 16 await treatment, 13 have had EMR only. There were 94 patients (80M) in our treatment group (RFA / EMR (34)). Median age of this group was 66 (3985); median M length 5cm (0-18); 67 (71%) had HGD or IMC as worst prior pathology. Kaplan-Meier analysis shows 96% of the treatment group achieved CR-D within 30m and 81% achieved CR-BE within 36m. Median time to CR-D was 7.4m (0.4-29.2), median RFA 2 (1-6). Median time to CR-BE 12.4m (2-34.4); median RFA 2(1-6). Of 138 EMR procedures there was one perforation requiring surgery and seven hospital admissions for observation. Of 202 RFA procedures there were 5 complications requiring admission (2 post-RFA bleeds). Conclusion: Our data supports that RFA combined with EMR is effective in achieving CR-D and CR-BE in the majority of patients with dysplastic BE and offers an alternative to surgery with low risk of serious complication. Ongoing follow-up of this cohort is needed to determine durability of treatment. There exists a subgroup of patients with dysplastic BE who have poorer response to RFA. Further studies are needed to determine risk factors for poor responders." @default.
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• W2285569199 title "283 Patients Undergoing Radiofrequency Ablation (RFA) for Barrett's Related Neoplasia Have Improved Outcomes With Decreasing Length's of Baseline Barrett's Eosophagus (BE) and Increasing Number of RFA Sessions" @default.
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