PTU-014 Safety and efficacy of endoscopic resection followed by radiofrequency ablation for Barrett's high-grade dysplasia and intramucosal cancer

Abstract

<h3>Introduction</h3> Endoscopic resection (ER) is a minimally invasive treatment for Barrett9s high-grade dysplasia (HGD) and intramucosal cancer (IMC). However, a significant proportion of patients may develop malignant transformation of remaining Barrett9s. Radiofrequency ablation (RFA) is a new, safe and effective modality for eradicating dysplasia and intestinal metaplasia. However there are limited data on the safety and efficacy of a combined approach including ER followed by RFA. <h3>Methods</h3> The aim was to assess the feasibility, safety and efficacy of the combined approach. Patients were enrolled from two tertiary referral centres in UK, as part of a multicentre European trial (EURO II). All visible mucosal lesions were removed by ER. RFA was carried out at 6–8 weekly intervals for a maximum of five sessions. HALO 360 were used for circumferential ablation followed by HALO 90 for any remaining islands. <h3>Results</h3> 20 patients (average age 63, 19 males) with a mean Barrett9s length of 4.8 cm (range 2–11 cm) underwent ER of visible mucosal lesions. All patients had Paris 0-II lesions (IIa-14, IIb-5 and IIc-1) with a mean size of 12 mm (range 4–20 mm). ER was carried out using multiband mucosectomy device in 19 patients and ER cap in one patient. En-bloc resection was achieved in eight cases, the rest requiring a piecemeal approach. 10 (50%) patients were up-staged from HGD to IMC following ER. RFA was carried out at least 6 weeks after ER. After a median follow-up of 11 months (IQR 7.5–16.5) and a mean of 2.2 (range 1–5) RFA sessions, none of the patients had residual or recurrent dysplasia. On average, the combined approach resulted in 90% reduction in the endoscopically-observed extent of Barrett9s mucosa. In eight patients who had completed the treatment regimen, complete histological resolution of intestinal metaplasia was achieved. Three patients (15%) developed minor procedure-related complications including 1 food bolus obstruction which was managed endoscopically, 1 superficial mucosal tear and 1 episode of self-limiting chest pain. <h3>Conclusion</h3> Endoscopic resection followed by radiofrequency ablation is a feasible, safe and effective approach for eradicating dysplasia and intestinal metaplasia in Barrett9s oesophagus. Long-term follow-up is warranted before this treatment modality could be implemented in routine clinical practice.