Endoscopic therapy for Barrett’s oesophagus with high grade dysplasia or intramusocal adenocarcinoma in Northern Ireland.

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Introduction

The 2013 British Society of Gastroenterology (BSG) guideline now supports first line use of endoscopic therapy in patients with Barrett’s oesophagus and high grade dysplasia (HGD) or intramucosal carcinoma (IMC)1. Endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) can be used instead of oesphagectomy in fit patients and allows treatment of patients unfit for surgery.

Aims

To evaluate the success rates of EMR and RFA in treating patients with low grade dysplasia (LGD), HGD and IMC in a tertiary referral centre in Belfast.

Methods

We compiled a database of patients using a consultant’s own database and search of endoscopy reporting system for ‘RFA’, ‘EMR’ and ‘HALO’. We retrospectively gathered histology and follow up data using patient letters and laboratory records.

Results

59 patients (50M:9F) with average age 79.5 received EMR/RFA for LGD, HGD or IMC. Initial histology demonstrated 43 HGD, 5 LGD and 11 IMC. The average Prague Classification where available was C3M5. This population cohort underwent 103 EMR’s (average 1.91) and 65 RFA’s (average 1.81). After treatment, 42.4% of patients had complete eradication of dyplasia. 15.3% had their lesions downgraded from IMC/HGD to HGD/LGD and these, along with a further 20.3% of patients are having ongoing endoscopic treatment of dysplasia. 11 patients (18.6%) proceeded to oesophagectomy. Surgical specimens demonstrated that 6 of these patients had HGD, IMC or submucsal adenocarcinoma, while 5 had Barrett’s metaplasia only.

Conclusion

Endoscopic therapy for advanced Barrett’s oesophagus is safe and effective and likely to play a major role in future management of IMC/HGD and LGD2. 1. Fitzgerald RC, di Pietro M, Ragunath K et al. Guidelines on the Diagnosis and Management of Barrett’s Oesophagus. BSG guidelines 2013 2. Phoa KN et al. Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia. JAMA. 2014;311(12):1209-1217.