Mo1291 SIMPLIFIED VERSUS STANDARD REGIMEN FOR FOCAL RADIOFREQUENCY ABLATION OF SHORT SEGMENT DYSPLASTIC BARRETT’S ESOPHAGUS ARE EQUALLY EFFECTIVE: SHOULD WE KEEP IT SIMPLE?

Abstract

Focal radiofrequency ablation (RFA) of Barret’s esophagus islands using a simplified regimen (3x15 J/cm2, without cleaning) has proven to be as effective as the standard regimen (2x15 J/cm2, followed by cleaning, 2x15 J/cm2). However, studies using a lower radiofrequency energy (12 J/cm2) and specifically short segment Barrett’s (SSBE) are limited. Our aim was to compare the short-term efficacy of the simplified protocol regimen using 12 J/cm2 to the standard regimen for ablating SSBE. All SSBE patients that underwent focal RFA from January 2015 to November 2019 at Tampa General Hospital were reviewed. The patients undergoing simplified regimen (3×12 J/cm2, without cleaning) or the standard regimen were compared. Demographic data, length of Barrett’s, number of RFA sessions, level of dysplasia, and procedure time were included. The primary outcome was complete endoscopic and histological regression of dysplasia and intestinal metaplasia. Secondary outcomes included rate of stenosis, total procedure time and total number of sessions. Patient that received circumferential radiofrequency ablation, cryotherapy, previous mucosa resection or history of adenocarcinoma were excluded. Out of 139 patients, a total of 20 patients met inclusion criteria. 10 underwent the simplified and standard protocol each. Patient characteristics are available in Table 1. Patient characteristics were similar in both groups including the median Prague Score (C0M2 simplified vs C1M2 standard), high-grade dysplasia (30% simplified vs 60% standard), and presence of islands (40% simplified vs 30% standard). There was no difference in the biopsy-proven complete eradication between the two groups (40% simplified vs 50% standard, p=0.337), endoscopic surface regression (40% simplified vs. 70% standard, p=0.098), and procedure time (22 min simplified vs. 19 min standard, p=0.659).There was a significant difference in the number of RFA sessions required (1.9 simplified vs 3.3 standard, p=0.05). Two patients developed stenosis in the standard group, one requiring dilation. No patients in the simplified group developed stenosis. Compared to the standard method, the simplified method of RFA using 12 J/cm2 is as effective for treatment of SSBE. Our data, while limited due to a small sample size, did show a decrease in the total number of RFA sessions required to achieve eradication in the simplified group. Additionally, we did not find a higher rate of stenosis in the simplified group. Larger, randomized controlled trials are needed to confirm these findings further.View Large Image Figure ViewerDownload Hi-res image Download (PPT)