Focal Endoscopic Resection Research Articles

Radiofrequency Ablation and Focal Endoscopic Resection in Barrettʼs Esophagus Treatment: A Single-Center Experience

Introduction: Radiofrequency ablation (RFA) or focal endoscopic resection (ER) followed by RFA safely and effectively eradicates the Barrett's esophagus (BE) with or without dysplasia. However, little is known about the total required treatment sessions to achieve a complete cure when comparing both (RFA alone versus ER+RFA) methods. Herein, we report 2-year experience of treating BE with both approaches. Methods: All patients undergoing treatment for BE with RFA or RFA/ER at a tertiary care center between January 2014 and December 2015 were included in the analysis. Patients who got their initial treatment session before 2014 were included after adding those sessions to the overall number of treatment sessions. Patients who underwent APC tissue destruction as a last treatment session for minute Barrett's islands and then followed by their referring physician were considered as a complete cure. Patients who haven't received their last treatment were excluded. (Figure 1) Tables 1 and 2 show patients demographics and the data collected. Initial biopsy results from the referring physician were compared with the biopsy after the last treatment session to evaluate the complete eradication of intestinal metaplasia (CE-IM) and/or Dysplasia/Intramucosal Carcinoma (CE-D/IMC). Subjects were divided into 2 main groups: Dysplasia/IMC and Intestinal Metaplasia (IM). Comparison was made among patients who underwent RFA or RFA/ER in each main group. (Tables 1 + 2)Figure 1Table 1: Patients who had intestinal metapalsia onlyTable 2: Patients who had Dysplasia/IMCResults: 74 patients with a mean age of 66.5±9.4 years (83% males) were included. Median BE length was 3 cm (range 1-15). Ten patients presented as a recurrence after complete eradication from prior therapy at another facility. 1. Dysplasia/IMC Group: 51 patients were identified (24 RFA + 27 RFA/ER). Median number of total required sessions was 2 in RFA group and 4 in RFA/ER group (p = 0001). CE-D/IMC was achieved in 24 (100%) and 25 (92.6%) patients among RFA and RFA/ER groups respectively. ER 2. Intestinal Metaplasia Group: 23 patients were identified (19 RFA + 4 RFA/ER). The median number of total required sessions was 2 and 4 among RFA and RFA/ER groups respectively (p= 0.0165). There was no significant difference in complications among the RFA and RFA/ER patients. Conclusion: RFA and RFA/ER are safe and effective methods for the treatment of BE. However, patients who were treated with RFA/ER required higher number of overall treatment sessions compared to RFA only.

PTU-047 Acetic acid guided focal endoscopic resection without rfa remains an effective treatment for barrett’s neoplasia: time to reassess the role of rfa?: Abstract PTU-047 Table 1

Introduction Endoscopic resection (ER) is an established effective treatment for Barrett’s neoplasia. ER can lead to recurrence due to residual neoplasia left behind, so it is suggested that all patients should undergo radiofrequency ablation (RFA) after ER. Acetic acid chromoendoscopy has been shown to be an effective method of localising and delineating dysplastic areas of Barrett’s oesophagus and we aim to review the outcome of Acetic Acid guided focal ER without RFA in our patients. Method All ER procedures between January 2005 and November 2014 were recorded in a prospective database which was analysed. Acetic acid guided focal ER was the treatment strategy with the aim of removing all neoplasia visible with acetic acid chromoendoscopy. RFA was not used in this group. Results 112 patients were treated for dysplastic Barrett’s oesophagus or early Barrett’s cancer by ER. The mean age at first procedure was 68 years and 82% of the patients were male. Mean initial Barrett’s length was 5.1 cm. 35 of 112 patients had advanced histological features on the initial ER specimen and were referred for radical cure. The remaining 77 cases showed; intramucosal cancer (IMC) in 46, high grade dysplasia (HGD) in 28 and low grade dysplasia in 3. All 77 cases have follow-up data with a mean duration of 5.4 years. 67 of 77 cases (87%) have sustained eradication of HGIN/IMC after focal ER. 10 patients (13%) developed further neoplasia during follow up. 5/10 patients (6.5%) developed invasive cancer in the residual Barrett’s, all were diagnosed endoscopically and successfully managed with radical curative treatment. Focal ER was successful in a mean of 1.3 procedures per patient (range 1–3). Complication rate was 4% (4 bleeds, 2 strictures). No additional RFA was performed in this patient group. Table 1compares our outcomes with UK HALO registry outcomes where all patients receive RFA. Conclusion Acetic acid guided ER is an effective and safe treatment for dysplastic Barrett’s oesophagus. Progression to cancer after acetic acid guided ER is equivalent to the reported rate of progression after EMR+RFA. 1 Equal rates of sustained eradication of HGIN/IMC are achieved. An acetic acid+ER strategy is potentially much cheaper than an ER+RFA strategy. This data calls for a better stratification of patients who require RFA after ER. Disclosure of interest None Declared. Reference Haidry, et al . Gastroenterology 2013; 145 :87–95

Remission of Barrett's Esophagus With Early Neoplasia 5 Years After Radiofrequency Ablation With Endoscopic Resection: A Netherlands Cohort Study

Radiofrequency ablation (RFA), with or without endoscopic resection effectively eradicates Barrett's esophagus (BE) containing high-grade intraepithelial neoplasia and/or early-stage cancer. We followed patients who received RFA for BE containing high-grade intraepithelial neoplasia and/or early-stage cancer for 5 years to determine the durability of treatment response. We followed 54 patients with BE (2-12 cm), previously enrolled in 4 consecutive cohort studies in which they underwent focal endoscopic resection in case of visible lesions (n= 40 [72%]), followed by serial RFA every 3 months. Patients underwent high-resolution endoscopy with narrow-band imaging at 6 and 12 months after treatment and then annually for 5 years (median, 61 months; interquartile range, 53-65 months); random biopsy samples were collected from neosquamous epithelium and gastric cardia. After 5 years, endoscopic ultrasound and endoscopic resection of neosquamous epithelium were performed. Outcomes included sustained complete remission of neoplasia or intestinal metaplasia (IM), IM in gastric cardia, or buried glands in neosquamous epithelium. After 5 years, Kaplan-Meier analysis showed sustained complete remission of neoplasia and intestinal metaplasia in 90% of patients; neoplasia recurred in 3 patients and was managed endoscopically. Focal IM in the cardia was found in 19 of 54 patients (35%), in 53 of 1143 gastric cardia biopsies (4.6%). The incidence of IM of the cardia did not increase over time; and IM was diagnosed based on only a single biopsy in 89% of patients. Buried glands were detected in 3 of 3543 neosquamous epithelium biopsies (0.08%, from 3 patients). No endoscopic resection samples had buried glands. Among patients who have undergone RFA with or without endoscopic resection for neoplastic BE, 90% remain in remission at 5-year follow-up, with all recurrences managed endoscopically. This treatment approach is therefore an effective and durable alternative to esophagectomy; www.trialregister.nl number, NTR2938.

Sa1529 Radiofrequency Ablation +/- Endoscopic Resection for Barrett's Esophagus With High-Grade Dysplasia and/or Early Cancer: Durability of the Post-Treatment Neosquamous Epithelium At 5-Year Follow-Up

Radiofrequency ablation (RFA) is safe and effective for complete eradication of Barrett's esophagus (BE) with high-grade dysplasia (HGD) and/or early cancer (EC), and may be safely preceded by focal endoscopic resection (ER) to remove visible lesions. Less is known regarding the long-term (5-year) durability of the neosquamous epithelium (NSE) that repopulates the esophagus after RFA.

Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett's oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial

ObjectiveAfter focal endoscopic resection (ER) of high-grade dysplasia (HGD) or early cancer (EC) in Barrett's oesophagus (BO), eradication of all remaining BO reduces the recurrence risk. The aim of this...

587a: Safety Outcomes of Balloon-Based Circumferential Radiofrequency Ablation After Focal Endoscopic Resection of Early Barrett's Neoplasia in 118 Patients: Results of an Ongoing European Multicenter Study

587a: Safety Outcomes of Balloon-Based Circumferential Radiofrequency Ablation After Focal Endoscopic Resection of Early Barrett's Neoplasia in 118 Patients: Results of an Ongoing European Multicenter Study