VICTORIAN BARRETT’S EXPERIENCE: OUTCOMES OF PATIENTS UNDERGOING COMBINATION ENDOSCOPIC THERAPY FOR DYSPLASTIC BARRETT’S OESOPHAGUS — ASN Events
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  3. VICTORIAN BARRETT’S EXPERIENCE: OUTCOMES OF PATIENTS UNDERGOING COMBINATION ENDOSCOPIC THERAPY FOR DYSPLASTIC BARRETT’S OESOPHAGUS

VICTORIAN BARRETT’S EXPERIENCE: OUTCOMES OF PATIENTS UNDERGOING COMBINATION ENDOSCOPIC THERAPY FOR DYSPLASTIC BARRETT’S OESOPHAGUS (#56)

Georgina Cameron 1 , Chatura Jayasekera 2 , Richard Williams Williams 1 , Finlay Macrae 2 , Paul Desmond 1 , Andrew Taylor 1
  1. St Vincents Hospital Melbourne, Fitzroy, Vic, Australia
  2. Royal Melbourne Hospital, Melbourne, Australia

Background: HALO radiofrequency ablation (RFA) combined with endoscopic mucosal resection (EMR) for visible lesions is highly effective in eradicating dysplastic Barrett’s oesophagus (BE) and provides a credible alternative to surgery for high grade dysplasia (HGD) and early mucosal cancer (IMC) in BE.

Aims: To assess safety and efficacy of combination endoscopic therapy in patients with dysplastic BE in a Victorian cohort.

Methods: Data from the Victorian Barrett’s HALO Database were analysed. The Database comprises patients referred to St Vincent’s (SVH) and Royal Melbourne (RMH) Hospitals from 2008 to May 2012 for endoscopic management of BE. Patients were assessed endoscopically and underwent EMR of visible lesions. Subsequent staging investigations (EUS/PET/CT), management (EMR/HALO) and histopathological outcomes were recorded prospectively.

Results: 138 patients were assessed (111 SVH, 27 RMH). 23 were considered inappropriate for endoscopic therapy (20 referred for surgery/chemoradiotherapy, 1 unfit, 2 non-dysplastic BE) and 1 opted out, leaving 114 patients (93 males; median age 68 years (40-86)) who were appropriate for endoscopic therapy; 60 with HGD/IMC at referral; median length of BE 5cm (0-18). Compared to worst pathology at referral, following endoscopic assessment 19 patients had upgrading of pathology; 28 were downgraded. 11 await treatment, 26 have only had EMR to date. 77 patients had HALO (median 2 sessions (1-6)). 39 reached complete remission of intestinal metaplasia (CR-IM); 38 remain on treatment protocol. 9 achieved CR-IM after 1 HALO, 16 after 2 HALO, 8 after 3 HALO, and 6 (median length BE 7.5cm (5-14)) required 4-6 HALO to achieve CR-IM. Of the 38 patients still on treatment, 6 had >3 HALO (4-6) sessions. Of the 77 patients treated with HALO, 45 (median BE length 5cm (0-15) achieved complete remission of dysplasia (CR-D) in a median 2 HALO (1-6) sessions. 38 of 45 achieved CR-D in ≤3 HALO; 7 reached CRD in >3 HALO. Of the 39 who completed treatment the median duration of follow-up was 16 months (5-54) from time of last HALO to present. 35 remain in remission. 4 patients achieved CR-IM & CR-D at one point but were found to have HGD on subsequent gastroscopy. 2 patients progressed on treatment from HGD to IMC and were referred for oesophagectomy. 125 EMR procedures were performed in 64 patients during staging/treatment with 2 significant complications occurring (oesophageal perforation, bleeding).

Conclusion: Combination endoscopic therapy is effective for eradication of dysplasia and intestinal metaplasia in the majority of patients with dysplastic BE and offers an alternative to surgery with low risk of serious complication. Ongoing follow-up of this cohort is needed to determine durability of treatment. There exists a subgroup of patients with dysplastic BE who have poorer response to HALO RFA. Further studies are needed to determine risk factors for poor responders.

  1. Shaheen et al. Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. N Engl J Med 2009;360:2277-88.
  2. Pouw RE, Wirths K, Eisendrath P et al. Efficacy of Radio-frequency Ablation Combined with Endoscopic Resection for Barrett’s Oesophagus for early Neoplasia. Clin Gastroenerol Hepatol. 2009.