Eradication Of Intestinal Metaplasia Research Articles

A127 ENDOSCOPIC MUCOSAL RESECTION FOR DYSPLASTIC AND NEOPLASTIC BARRETT’S ESOPHAGUS: FINDINGS FROM A FOREGUT NEOPLASIA MULTIDISCIPLINARY DATABASE

Abstract Background Previously, Barrett’s esophagus with high grade dysplasia (HGD) or neoplasia was treated with esophagectomy, which is associated with a high postoperative morbidity and mortality rate. Recent guidelines support the use of endoscopic mucosal resection (EMR) for T1a esophageal adenocarcinoma (EAC) and potentially T1b EAC; however, data on long term outcomes of endoscopic treatment is lacking. We created a combined prospective and retrospective multidisciplinary database to monitor outcomes of patients with Barrett’s esophagus undergoing endoscopic treatment. Aims Our primary aim was to compare outcomes of EMR and esophagectomy in patients presenting with BE and HGD, and/or early EAC. Methods A collaboration of gastroenterologists, general surgeons and thoracic surgeons from the University of Alberta, Edmonton, Alberta, provided input on the development of the database. All patients referred to the Northern Alberta Endoscopic Ablation Program from 2009–2021 who received at least one endoscopic treatment were included. A sub-analysis of all patients with pathologic confirmation of HGD, and/or early EAC was conducted to compare outcomes of EMR and esophagectomy. Results A total of 212 patients have been entered into the database. The most common findings were HGD, low grade dysplasia (LGD), and adenocarcinoma, respectively. All patients (n=48) who had at least LGD reached complete eradication of dysplasia (CE-D) and 95.8% reached complete eradication of intestinal metaplasia (CE-IM). Of those patients that reached CE-D, 8.3% developed recurrence of dysplasia (n=4). In the sub-analysis, 74 patients (76.3%) received endoscopic therapy while 23 patients (23.7%) received endoscopic therapy then ultimately an esophagectomy. There were significantly more T1b lesions in the esophagectomy group compared to the EMR group ( p<0.0001). Of all the patients in the EMR group, only 5.4% (n=4) had treatment related complications. Of patients receiving an esophagectomy, 60.9% (n=14) experienced treatment related complications. The mean length of stay for patients in the EMR group was 1.03 +/- 0.2 days, compared to 16.5 +/- 11.8 days for esophagectomy ( p<0.0001). Conclusions EMR provides definitive and durable treatment for BE lesions classified as T1b or less severe, with fewer complications and a shorter length of hospital stay than esophagectomy. Funding Agencies Alberta Innovates Health Solutions

Radiofrequency ablation for Barrett\u2019s oesophagus related neoplasia with the 360 Express catheter: initial experience from the United Kingdom and Ireland\u2014preliminary results

BackgroundRadio-frequency ablation (RFA) for Barrett’s oesophagus (BE)-related neoplasia is currently used after endoscopic resection of visible neoplasia. The HALO 360 balloon has been used to ablate long segment BE. The Barrx™ 360 Express RFA self-sizing catheter (‘RFA Express’) may potentially allow quicker ablation times and improved treatment outcomes. The aim of this paper is to present real world data on the use of the 360 Express Device.MethodsCentres in the UK and Ireland submitted cases where the RFA Express was used. The primary outcome was regression of BE at 3 months. Secondary outcomes were the rate of symptomatic stricture formation and resolution of intestinal metaplasia (CR-IM) and dysplasia (CR-D) at End of Treatment (EoT).Results11 centres submitted 123 consecutive patients. 112 had a follow up endoscopy. The median age was 67 years (IQR 62–75). 3 dosimetries were used. The mean reduction in Circumferential (C) length was 78% ± 36 and mean reduction in Maximal length (M) was 55% ± 36. 17 patients (15%) developed strictures requiring dilation. There was a higher rate of stricture formation when the 12 J energy was used (p < 0.05). 47 patients had EoT biopsies, 40 (85%) had CR-D and 34(76%) had CR-IM.ConclusionsThe RFA 360 Express catheter shows reduction in length of baseline BE at 3 months after index treatment, and eradication of intestinal metaplasia and dysplasia at 12 months similar to other studies with earlier devices. It appears that the symptomatic stricture rate is slightly higher than previous series with the HALO 360 catheter.This study was performed as part of the HALO registry and has been approved by the Research Ethics Committee - MREC Number 08/H0714/27 Local project reference 08/0104 Project ID 15,033 IRAS Number 54678 EudraCT 2009-015980-1. Registered on ISRCTN as below: ISRCTN93069556. https://doi.org/10.1186/ISRCTN93069556

Resection of early esophageal neoplasms: The pendulum swings from surgical to endoscopic management.

Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world. The standard treatment is esophagectomy which is associated with significant morbidity and mortality. This led to development of minimally invasive, organ sparing endoscopic therapies which have comparable outcomes to esophagectomy in early cancer. These include endoscopic mucosal resection and endoscopic submucosal dissection. In early squamous cell cancer, endoscopic submucosal dissection is preferred as it is associated with cause specific 5-year survival rates of 100% for M1 and M2 tumors and 85% for M3 and SM1 tumors and low recurrence rates. In early adenocarcinoma, endoscopic resection of visible abnormalities is followed by ablation of the remaining flat Barrett’s mucosa to prevent recurrences. Radiofrequency ablation is the most widely used ablation modality with others being cryotherapy and argon plasma coagulation. Focal endoscopic mucosal resection followed by radiofrequency ablation leads to eradication of neoplasia in 93.4% of patients and eradication of intestinal metaplasia in 73.1% of patients. Innovative techniques such as submucosal tunneling with endoscopic resection are developed for management of submucosal tumors of the esophagus. This review includes a discussion of various endoscopic techniques and their clinical outcomes in early squamous cell cancer, adenocarcinoma and submucosal tumors. An overview of comparison between esophagectomy and endoscopic therapy are also presented.

521 – Number of Sessions to Achieve Complete Eradication of Intestinal Metaplasia (CE-IM) Predicts Recurrence in Barrett's Esophagus (BE) Patients Undergoing Endoscopic Eradication Therapy (EET): Results from the Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus (Treat-Be) Consortium

521 – Number of Sessions to Achieve Complete Eradication of Intestinal Metaplasia (CE-IM) Predicts Recurrence in Barrett's Esophagus (BE) Patients Undergoing Endoscopic Eradication Therapy (EET): Results from the Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus (Treat-Be) Consortium

1070 – When Should We Look for Recurrence Following Complete Eradication of Intestinal Metaplasia (CE-IM)? Results from the Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus (Treat-Be) Consortium

1070 – When Should We Look for Recurrence Following Complete Eradication of Intestinal Metaplasia (CE-IM)? Results from the Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus (Treat-Be) Consortium

Natural History of the Post-ablation Esophagus.

Endoscopic ablative therapy including radiofrequency ablation (RFA) represents the preferred management strategy for dysplastic Barrett's esophagus (BE) and appears to diminish the risk of developing esophageal adenocarcinoma (EAC). Limited data describe the natural history of the post-ablation esophagus. Recent findings demonstrate that recurrent intestinal metaplasia (IM) following RFA is relatively frequent. However, dysplastic BE and EAC subsequent to the complete eradication of intestinal metaplasia (CEIM) are uncommon. Moreover, data suggest that the risk of recurrent disease is probably highest in the first year following CEIM. Recurrent IM and dysplasia are usually successfully eradicated with repeat RFA. Future studies may refine surveillance intervals and inform the length of time surveillance should be conducted following RFA with CEIM. Further data will also be necessary to understand the utility of chemopreventive strategies, including NSAIDs, in reducing the risk of recurrent disease.

Acid Reflux Control Aids Success in Barrett Esophagus Ablation

Poorly controlled gastroesophageal reflux is implicated as a risk factor for recurrence of Barrett esophagus (BE) after endoscopic eradication therapy (EET), recently estimated at an annual rate of 9.6% (NEJM JW Gastroenterol Nov 9 2016; [e-pub] and Am J Gastroenterol 2017; 112:87). However, the magnitude of the effect is unclear. In a single-center observational study, researchers assessed complete eradication of intestinal metaplasia and its recurrence in 221 consecutive patients with BE who were managed with …

Tu1566 Efficacy of Endoscopic Mucosal Resection (EMR) in Eradication of Barrett's Esophagus Related Neoplasia: a Meta-Analysis and Systematic Review

Tu1566 Efficacy of Endoscopic Mucosal Resection (EMR) in Eradication of Barrett’s Esophagus Related Neoplasia: a Meta-Analysis and Systematic Review Madhav Desai*, Neil Gupta, Prashanth Vennalaganti, Ajay Bansal, Abhishek Choudhary, Mohammad A. Titi, Cesare Hassan, Prateek Sharma, Alessandro Repici Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, KS; Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL; Gastroenterology and hepatology, Veteran Affairs Medical Center, Kansas City, Kansas City, MO; Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy; Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy Background: Complete endoscopic mucosal resection [EMR] is an established approach for complete eradication of Barrett’s esophagus [BE] related neoplasia: high-grade dysplasia [HGD] and early adenocarcinoma [EAC]. However, efficacy rates in a large cohort of BE patients undergoing EMR as the primary eradication modality are not known. Methods: Two investigators independently identified potentially relevant studies through a search of MEDLINE and ISI Web of Knowledge (1980-2014), Cochrane Central Register of Controlled Trials, clinicaltrials.gov and bibliographic review of secondary sources. Search terms were: “Barrett’s e/oesophagus”, “Endoscopic mucosal resection” (EMR), “endoscopic resection”, dysplasia, adenocarcinoma. Inclusion criteria were: complete or step wise EMR, human studies, patient age 18 years or greater, prospective and retrospective studies, high grade dysplasia [HGD], superficial esophageal adenocarcinoma, sample size of 10 patients or greater and follow up of greater than 1 year. Exclusion criteria were: case reports, conference or symposium abstracts, abstract form only, review articles, Non English language articles, editorials, letters to editors, studies without biopsy proven BE, studies not reporting either efficacy or recurrence, duplicate reports of study samples. Primary outcome was complete eradication of neoplasia [CE-N (HGD/ EAC)]. Secondary outcomes were: 1) Complete eradication of intestinal metaplasia (CE-IM), 2) adverse events and 3) recurrence rates of -EAC, D and IM. Results: The initial composite search identified 22 studies; 10 studies met all the criteria and were included in the final analysis. This included a total of 620 patients, 83% males with a mean age of 66 years. The average follow up duration was 25.6 months [range 15 to 40.6 months]. Sustained CE-N was achieved in 95.7% [530/554] of the patients with CE-IM in 78% [397/508]. The major adverse events reported were: perforation 1.8% (11/620), symptomatic strictures 36.5% (226/620) and significant bleeding 8.2% (51/ 620). The estimated recurrence was: EAC 1.7% (10/574), Dysplasia 3.9% (22/565) and IM 14.3% (75/524). No deaths related to the procedure were reported. Conclusion: EMR, as the primary therapy for eradication of BE related neoplasia, appears to be a highly effective strategy. However, recurrence of intestinal metaplasia and neoplasia occurs in approximately 20% of the treated patients after initial successful eradication. Strictures related to therapy are reported in up to a 1/3 of the patients.

Tu1559 Safety of Same-Session Cryotherapy and Esophageal Stricture Dilation in the Treatment of Esophageal Neoplasia- a Multicenter Study

Tu1559 Safety of Same-Session Cryotherapy and Esophageal Stricture Dilation in the Treatment of Esophageal Neoplasia- a Multicenter Study

Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus–related dysplasia is safe and effective

Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE) dysplasia. For patients with dysplasia refractory to RFA, data are limited regarding efficacy of endoscopic therapy. To assess the efficacy and safety of cryotherapy in patients with BE dysplasia who failed RFA. Single-center, retrospective, cohort study. Tertiary-care center between 2006 and 2013. Patients with BE and low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (IMC) were referred for RFA every 2 to 3 months. Response was determined by complete eradication of dysplasia (CE-D). Patients without CE-D or those with recurrent dysplasia after initial eradication were offered cryotherapy. Eradication of dysplasia and/or cancer. Secondary outcome, eradication of intestinal metaplasia. A total of 121 patients underwent RFA for BE dysplasia (55% HGD, 26% LGD, 17% IMC, 2% indefinite dysplasia). After a median of 3 RFA sessions, 75% (n = 91) had CE-D. Patients without CE-D were more likely to have a longer BE length (7 cm vs 4 cm; P = .004) and a hiatal hernia (83% vs 55%; P = .005). Sixteen patients (14 with failed CE-D and 2 with recurrent dysplasia) were offered cryotherapy and had endoscopic follow-up. Seven (57%) had HGD before cryotherapy (6 with LGD, 2 with IMC, and 1 with indefinite dysplasia). After cryotherapy, 12 (75%) had CE-D, and 5 (31%) had eradication of intestinal metaplasia. Of patients with IMC, 100% had CE-D. Three patients developed strictures that responded to dilation. Single center, retrospective nature of study. For patients with refractory dysplasia or recurrent dysplasia after RFA, salvage cryotherapy is a safe and effective endoscopic therapy.

742 Rates of Recurrence and Achievement of a Second Complete Eradication of Intestinal Metaplasia in Patients Treated With Radiofrequency Ablation for Barrett's Esophagus

742 Rates of Recurrence and Achievement of a Second Complete Eradication of Intestinal Metaplasia in Patients Treated With Radiofrequency Ablation for Barrett's Esophagus

Sa1074 Increased Number of Risk Factors Predicts Esophageal Injury and Metaplasia: Results From a Large Prospective Population-Based Study

modalities were included in this analysis. Patients who stopped EET and started surveillance prior to CE-IM were excluded. Complete eradication of intestinal metaplasia (CE-IM) was defined as having an endoscopy with no visible columnar lined epithelium in the tubular esophagus and biopsies of the neo-squamous mucosa showing no intestinal metaplasia. Patients were considered to have achieved CE-IM if they had done so with 2cm were less likely to achieve CE-IM compared to those with C extents ≤2cm (64.3% vs. 73.5%, p=0.027). Patients with M extents of > 3cm were less likely to achieve CE-IM compared to those with M extents ≤3cm (61.2% vs. 88.4%, p<0.001). Conclusions: Results of this multi-center effectiveness trial show that pre-treatment Barrett's esophagus extent as measured by the Prague criteria is associated with the rate of achieving CE-IM with endoscopic eradication therapy. This was true for both the C and M extents of disease. This study provides the first validation of the Prague criteria with clinically relevant outcomes in the management of patients with Barrett's esophagus.

Sa1075 Volatile Organic Compounds in Blood for Non-Invasive Diagnosis of Barrett's Esophagus - A Pilot Study

modalities were included in this analysis. Patients who stopped EET and started surveillance prior to CE-IM were excluded. Complete eradication of intestinal metaplasia (CE-IM) was defined as having an endoscopy with no visible columnar lined epithelium in the tubular esophagus and biopsies of the neo-squamous mucosa showing no intestinal metaplasia. Patients were considered to have achieved CE-IM if they had done so with 2cm were less likely to achieve CE-IM compared to those with C extents ≤2cm (64.3% vs. 73.5%, p=0.027). Patients with M extents of > 3cm were less likely to achieve CE-IM compared to those with M extents ≤3cm (61.2% vs. 88.4%, p<0.001). Conclusions: Results of this multi-center effectiveness trial show that pre-treatment Barrett's esophagus extent as measured by the Prague criteria is associated with the rate of achieving CE-IM with endoscopic eradication therapy. This was true for both the C and M extents of disease. This study provides the first validation of the Prague criteria with clinically relevant outcomes in the management of patients with Barrett's esophagus.

106 Random Biopsies in Endoscopically Normal Esophagus Improve Yield of Recurrent Intestinal Metaplasia After Successful Radiofrequency Ablation

Background: Radiofrequency ablation (RFA) treatment for dysplastic Barrett's Esophagus (BE) is associated with high rates of complete eradication of intestinal metaplasia (CEIM). However, recurrence of intestinal metaplasia (IM) in the esophagus is seen in approximately 25% of patients. The endoscopic findings associated with recurrence of IM are poorly described. Methods: We conducted a retrospective study of patients who underwent RFA for BE at University of North Carolina Hospitals between 2006 and 2013. Patients who achieved CEIM with at least two subsequent surveillance endoscopies were included. Patients were excluded if treated for non-dysplastic BE or invasive esophageal adenocarcinoma. Among patients with histologic evidence of recurrent BE during surveillance, we assessed the endoscopic findings associated with the recurrence. All patients had assessment of the distal esophagus by high-resolution white light and narrow band imaging, and all underwent regular biopsies according to a standard four-quadrant, q1cm procedure, as well as biopsy of endoscopically suspicious lesions. Endoscopic signs recorded included esophageal nodules (Paris classifications 0-Ip, 0-Is, 0-IIa), and areas suspicious for recurrent BE based on mucosal color changes. Statistical analysis was performed using SAS (version 9.3). Results: Of 302 patients, 178 met criteria for inclusion. These patients had 673 biopsy sessions (mean 3.8 sessions/pt). In total, 19 patients had histological recurrence of IM in the tubular esophagus (11%). Of these 19, only 5 (26%) had any endoscopic abnormality suggesting recurrence on endoscopy (table). The remaining 14/19 (74%, 95% confidence interval (CI): 49-91%) were found on routine surveillance biopsies. Of the 17 patients biopsied for a raised lesion or mucosal change suspicious for recurrent IM, only 5 (29%) actually had recurrence; 12 such biopsies were negative for recurrent IM. The median location for recurrent IM in targeted biopsies was 1 cm (Mean 2.5, S.D. 4.3) proximal to the top of the gastric folds; most (75%) specimens indicative of recurrence were from within 2 cm of the top of the gastric folds (figure). The odds ratio for recurrent disease in the setting of endoscopic signs was 17.7 (p < 0.001). Histologic grade was significantly higher for recurrence accompanied by endoscopic signs compared to those found on random biopsy (p = 0.016 for trend). Subsquamous recurrence was not identified in any biopsies regardless of endoscopic signs (95% CI: 0-23%). Conclusion: Histologic recurrence of IM following RFA was most common near the gastroesophageal junction. Subsquamous recurrence was not an important factor in recurrence. Most recurrences were found on routine, non-targeted biopsies, but endoscopic signs of recurrence including nodularity or apparent columnar-lined esophagus are associated with improved biopsy yield. Histology of Apparent and Non-Apparent Recurrence or Progression

Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett's Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment

Figure 2. The irregularly-shaped resected specimen Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett’s Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment Cary C. Cotton*, W. Asher Wolf, Nan Li, Sarina Pasricha, Kelly E. Hathorn, Melissa Spacek, Susan E. Moist, Ryan D. Madanick, Evan S. Dellon, Nicholas J. Shaheen Center for Esophageal Diseases & Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC Background: Radiofrequency ablation (RFA) is a safe and effective treatment for Barrett’s esophagus (BE). The development of erosive esophagitis (EE) during treatment represents incomplete control of reflux, and may retard reversion to squamous www.giejournal.org Vol epithelium. Methods: We conducted a retrospective study of patients who underwent RFA for dysplastic BE at University of North Carolina Hospitals between March 16, 2006 and August 30, 2013. Patients were excluded for non-dysplastic BE and invasive esophageal adenocarcinoma. We used nonparametric statistics to analyze the impact of EE at the first endoscopy or development of EE during or after ablation on outcomes of RFA. We assessed 3 types of EE: 1) Prevalent EE was defined as EE of any grade at the initial endoscopy in a patient scheduled for RFA, 2) Incident treatment EE was defined as EE on any treatment endoscopy after the first treatment (but before attainment of complete eradication of intestinal metaplasia (CEIM)), and 3) Incident surveillance EE was defined as an initial occurrence of EE after CEIM had been attained, during routine endoscopic surveillance. Outcomes included the number of treatment endoscopies (defined as endoscopies where RFA or endoscopic mucosal resection was performed), the rate of CEIM, and the rate of IM recurrence. Risk factors for the three types of EE were identified. Statistical analysis was performed using SAS software (version 9.3.) Results: Of 302 patients, 283 met inclusion criteria. Of these, 15 patients had prevalent EE, 21 had incident treatment EE, and 17 had incident surveillance EE. Of 55 patients who had EE after the first endoscopy, 12 of these also had prevalent EE. Thus, 26 patients of 268 (9.7%) at risk developed EE during treatment and 17 patients of 201 (8.5%) who entered surveillance without prior EE developed EE during surveillance. Patients with prevalent EE received significantly more treatments (Figure; mean 4.0 vs. 3.0, p Z 0.045.) This association was also found with incident treatment EE (mean 4.0 vs. 2.9, p Z 0.005). Similar associations persisted in linear regression analysis with adjustment for segment length. Neither prevalent EE nor incident treatment EE was significantly associated with failure to reach CEIM. None of the 3 types of EE were significantly associated with intestinal metaplasia (IM) recurrence. Risk factors for prevalent EE or incident treatment EE included BE length, hiatal hernia and tobacco (table). Conclusion: Both prevalent EE at the time of baseline endoscopy as well as the development of EE during treatment are associated with an increased number of treatments necessary for successful reversion to squamous epithelium. Risk factors for prevalent EE and EE during RFA treatment include known risk factors for GERD. Control of GERD may predict the effort necessary to achieve successful reversion to squamous tissue in RFA. Risk Factors for Erosive Esophagitis by Phase of Treatment ume 79, N Prevalent Erosive Esophagitis (n [15) o. 5S : 2014 Incident Treatment Erosive Esophagitis (n[21) GASTROINTEST Incident Surveillance Erosive Esophagitis (n [17) INAL ENDOSCOPY All Patients (n[284) Mean / Percent Mean / Percent Mean / Percent Mean / Percent Age (years) 64.2 (N.S.) 64.1 (N.S.) 64.4 (N.S.) 67.9 BMI (kg/m2) 30.8 (N.S.) 30.7 (N.S.) 33.1 (pZ0.046) 29.7 Treatments (#) 4.0 (pZ0.045) 4.1 (pZ0.005) 2.6 (N.S.) 3.0 Prague M (cm) 5.4 (N.S.) 5.9 (pZ0.002) 3.9 (N.S.) 4.5

Mo1817 Dysplasia in the Gastric Cardia Is Not Uncommon Among Patients Who Are Successful Treated by Radiofrequency Ablation for Dysplastic Barrett's Esophagus -A Prospective Study

Background: Radiofrequency ablation (RFA) is effective and safe for eradicating dysplasia and intestinal metaplasia (IM) in patients with dysplastic Barrett's esophagus (BE). However, dysplasia or early cancer has been reported in the gastric cardia of patients who achieved complete eradication of intestinal metaplasia (CEIM). Our aim was to determine the prevalence of dysplasia in the endoscopically normal gastric cardia of patients who achieved CEIM in a tertiary care center. Methods: We performed a prospective cohort study of patients treated with RFA for BE who achieved CEIM at the University of North Carolina between 2012 and 2013. Data including demographics, medical history, worst histology, endoscopy findings, and complications were recorded on standardized case report forms. CEIM was defined as complete endoscopic resolution and at least one esophageal biopsy session after RFA demonstrating no IM. To assess for cardiac dysplasia, standard high resolution and narrow band imaging was performed. Then, a standardized study biopsy protocol, which included 4 quadrant biopsies at the top of the gastric folds, 1 cm into the cardia and 2 cm into the cardia (12 biopsies total) was utilized. The main outcome, the prevalence of dysplasia in the gastric cardia among patients who achieved CEIM, was calculated for the entire cohort and stratified by pre-treatment histology. Parametric and non-parametric tests were used to compare the baseline characteristics of patients who had dysplasia in gastric cardia versus patients without dysplasia. Results: 59 patients who achieved CEIM were prospectively enrolled. Of these patients, 4 (6.8%) demonstrated dysplasia in the gastric cardia. Three of these four patients had endoscopically normal appearing cardia; 1 patient had gastric nodularity. The demographic and BE baseline characteristics of patients who had dysplasia in gastric cardia were not significantly different from patients who did not demonstrate dysplasia (Table). When stratified by worst histology prior to RFA, the prevalence of dysplasia in the gastric cardia among patients who achieved CEIM was 6.3% (1 out of 16) for patients with low-grade dysplasia, 5.7% (2 out of 35) for patients with high-grade dysplasia, and 12.5% (1 out of 8) for patients with intramucosal carcinoma. The prevalence of gastric dysplasia did not differ by worst pre-treatment BE histology (P=0.770). Conclusions: Dysplasia in the endoscopically normal gastric cardia following successful eradication of dysplastic BE is not uncommon, with an overall prevalence of 6.8%.Most cases did not have visible nodularity endoscopically. The prevalence does not differ by worst BE histology prior to RFA treatment. Routine endoscopic surveillance of post-ablation patients achieving complete eradication of intestinal metaplasia should include routine surveillance gastric cardia biopsies. The characteristics of patients with dysplasia in gastric cardia vs. patients without dysplasia in gastric cardia

Tu1328 Endoscopic Submucosal Dissection for Barrett's Esophagus: Efficacy and Safety Results in a Large Tertiary Center Series of Patients

Tu1328 Endoscopic Submucosal Dissection for Barrett's Esophagus: Efficacy and Safety Results in a Large Tertiary Center Series of Patients

Focal Radiofrequency Ablation of Barrett's Esophagus as Add-On Treatment After Endoscopic Resection and HALO 360 Treatment

Radiofrequency ablation (RFA) has become the first-choice treatment for dysplastic Barrett's esophagus. RFA is indicated for flat high-grade dysplasia and for eradication of residual Barrett's esophagus after endoscopic resection of any visible lesion containing high-grade dysplasia or an early mucosal cancer. RFA has a high success rate for eradication of dysplasia in 95% of patients. Eradication of intestinal metaplasia can be obtained in approximately 80% of patients. This result can, however, only be obtained by a multiple step therapy with circumferential and subsequent focal ablation (HALO 90). This article is part of an expert video encyclopedia.

Circumferential Radiofrequency Ablation of a Long-Segment Barrett's Esophagus with Flat High-Grade Dysplasia Using the HALO 360 System

Radiofrequency ablation (RFA) has become the first choice for treatment of dysplastic Barrett's. RFA is indicated for flat high-grade dysplasia and for eradication of residual Barrett's after endoscopic resection of any visible lesion containing high-grade dysplasia or an early mucosal cancer. RFA has a high success rate for eradication of dysplasia in 95% of patients. Eradication of intestinal metaplasia can be obtained in approximately 80% of patients. This article is part of an expert video encyclopedia.

Su1467 Compliance With High-Dose Acid Suppression Does Not Appreciably Alter the Efficacy or Safety of Radiofrequency Ablation (RFA) in Barrett's Esophagus (BE): Results From the U.S. RFA Registry

Compliance With High-Dose Acid Suppression Does Not Appreciably Alter the Efficacy or Safety of Radiofrequency Ablation (RFA) in Barrett’s Esophagus (BE): Results From the U.S. RFA Registry Ryan D. Madanick*, William J. Bulsiewicz, Herbert C. Wolfsen, Charles J. Lightdale, William D. Lyday, George Triadafilopoulos, Evan S. Dellon, Richard I. Rothstein, Nicholas J. Shaheen University of North Carolina School of Medicine, Chapel Hill, NC; Mayo Clinic Florida, Jacksonville, FL; Columbia University School of Medicine, New York, NY; Atlanta Gastroenterology Associates, Atlanta, GA; Stanford University School of Medicine, Palo Alto, CA; Dartmouth University School of Medicine, Hanover, NH Background/Aim: Radiofrequency ablation (RFA) for Barrett’s esophagus (BE) requires adequate esophageal acid control to permit the growth of neosquamous epithelium. Currently patients are placed on high-doses of PPI (twice daily) during and after RFA treatment. However the effect of nonadherence to this regimen is unknown. The aim of this study was to assess the relationship between adherence to PPI and the efficacy and safety of RFA in BE in a nationwide registry. Methods: The U.S. RFA Registry is a prospective study of patients with BE treated with RFA at 148 institutions. Information collected includes demographic data, histology prior to treatment, endoscopic findings, date and number of treatment sessions, ablation outcomes, and complications. Self-reported PPI compliance with a regimen of twice daily PPI was assessed at each visit before therapy was given. Analysis was performed comparing those compliant at all visits to those partially or non-compliant. Our safety cohort consisted of all patients treated with RFA, while our efficacy cohort was restricted to subjects who had a biopsy performed 12 months or more after initial treatment. We compared safety and efficacy outcomes among those who were PPI compliant versus those partially/non-compliant using parametric tests for statistical comparisons. Safety outcomes included rates of stricture, GI bleeding, and hospitalization. Efficacy outcomes included complete eradication of intestinal metaplasia (CEIM), complete eradication of dysplasia (CED), and the number of treatment sessions to CEIM. Results: Among 5530 treated with RFA, 4580 (82%) were PPI compliant at all visits while 950 (17%) were partially (n 930) or noncompliant (n 20). There were no deaths. Rates of stricture (2.4% if compliant, 3.0% if partially or non-compliant), GI bleeding (0.4% if compliant, 0.5% if partially or non-compliant), and hospitalization (1.7% if compliant, 1.7% if partially or non-compliant) were similar regardless of PPI adherence (p 0.05). 2936 patients (53%) had a biopsy performed 12 months or more after treatment and were included in the efficacy analysis, including 2546 (81%) who were PPI compliant and 590 (19%) who were partially or non-compliant. The rates of CED (90%) were similar regardless of PPI adherence, however there was a trend toward higher rates of CEIM if PPI compliant (75% vs 71%, p 0.06). The mean number of treatments necessary to achieve CEIM was greater in patients who were PPI compliant (2.8) compared to those partially or non-compliant (2.6) (p 0.03). Conclusions: In a large, nationwide registry, most patients were compliant with a high dose (twice daily) PPI regimen. Among the over 700 patients who were not fully compliant, poor adherence to a high dose acid suppression regimen did not significantly alter the risk of complications or the likelihood of successful eradication of BE.