Su1123 NEAR UNIVERSAL SUCCESS WITH MULTIMODAL ENDOTHERAPY FOR DYSPLASTIC LONG- AND ULTRALONG-SEGMENT BARRETT'S ESOPHAGUS

Abstract

Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are established treatments for dysplastic Barrett's esophagus. Treatment of long segment and ultralong segment Barrett's esophagus (LSBE and ULSBE) with dysplasia or intramucosal carcinoma (IMC) may be associated with lower efficacy and higher complication rates. Although Barrett’s length is an independent predictor of neoplastic progression, there is limited literature regarding this high risk population. To determine the eradication rates, procedural burden and complication rates for patients with LSBE and ULSBE with low grade dysplasia (LGD), high grade dysplasia (HGD), or IMC treated at our center. We performed a retrospective analysis of patients who underwent endoscopic therapy for Barrett’s esophagus at the University of Washington between 2009 and 2014. Data on patient demographics, pathological diagnosis at entry, type of treatment, Barrett’s segment length, presence and size of hiatal hernia (HH), total number of treatment sessions, duration of follow up, and most recent pathology were collected. LSBE was defined as ≥3cm to <8cm and ULSBE as ≥8cm. Logistic regression analyses were used to identify clinical features that predicted treatment failure. A total of 378 patients were identified. After excluding patients with short segment BE (defined as <3cm), non-dysplastic BE, invasive adenocarcinoma and patients undergoing surveillance only, 31 cases of ULSBE and 69 cases of LSBE were included. Baseline demographics were similar in both groups (Table 1). Overall this was a high risk population but rates of dysplasia and IMC were similar between ULSBE vs LSBE: LGD (9.7% and 15.9%, p=0.4), HGD (54.8% and 62.3%, p=0.5) and IMC (35.5% and 21.7%, p=0.2). Complete remission of dysplasia (CRD), including IMC, was achieved in 92.9% of patients with ULSBE and 93.6% (p=0.9) of patients with LSBE. Complete remission of intestinal metaplasia (CRIM) was achieved in 71.4% vs 79.0% (p=0.4) for ULSBE and LSBE respectively. More treatments were required to achieve CRD in ULSBE compared to LSBE, and more treatments were required to achieve CRIM than CRD in both groups (Table 2). Complication rates were similar between groups, with strictures occurring at 22.6% and 21.7% (p=0.9) and bleeding at 32.3% and 31.9% (p=0.9) for ULSBE and LSBE, respectively. Recurrence of dysplasia and IM were similar between the two groups, over a mean follow up of 18 months. In this very high risk population we achieved near universal rates of CRD, and high rates of CRIM, with reasonable complication rates. Multimodal endotherapy is an effective strategy for treating dysplastic Barrett’s esophagus and IMC, even in ultra long segment, but requires repeated sessions for maximal efficacy. Even with successful treatment, ongoing surveillance is necessary.View Large Image Figure ViewerDownload Hi-res image Download (PPT)