P228\u2005Outcomes of RFA for Barrett’s mucosa: 10 years’ data from a tertiary centre

Abstract

Introduction Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is an established, effective and safe treatment for dysplastic Barrett’s oesophagus, aiming to cause complete regression to squamous mucosa. In high volume centres, complete remission of dysplasia (CR-D) is seen in 91%, and complete remission of intestinal metaplasia (CR-IM) in 83.9%1. Method The audit assessed the outcomes of all patients treated at the Royal Liverpool Hospital for Barrett’s mucosa with low grade dysplasia (LGD), high grade dysplasia (HGD) or intramucosal cancer (IMC) through RFA (HALO 360 or HALO 90) with or without EMR over a ten year period (2009–2019). The patients were treated by consultant gastroenterologists following referrals from throughout the Mersey region. Data was collated through the United Kingdom Radio Frequency Ablation Registry, which was regularly updated in this time period. Results 227 patients completed treatment in the 10 year period; 185 male and 42 female, with a median age of 68 years at time of first therapy (range 38–88). 45 had initial histology of LGD, 135 HGD, and 47 IMC. The median Barrett’s extension was C1 (range 0–15 cm) M4 (0–16 cm). 147 patients underwent EMR prior to RFA. The median number of ablations performed was 3 (range 2–12). Patients were followed up for a median of 1020 days (range 188–3557). As highlighted in the graphic, 209/227 (92.07%) patients achieved CR-IM at their latest endoscopy. Of those patients who have not achieved or maintained squamous mucosa upon completion of treatment, initial histology was predominantly HGD (12/18), with both LGD and IMC accounting for the remainder (3/18 each). Conclusion The data demonstrates a high proportion of patients receiving RFA for Barrett’s with dysplasia achieve CR-IM, exceeding national standards. Those whose initial histology was HGD or IMC were at higher risk of failing to achieve this. These outcomes, from a large dataset over an extended time period, highlight the level of expertise of the relevant endoscopists, and reinforce the benefit of therapy being undertaken in high volume centres. Reference Alzoubaidi D, Ragunath K, Wani S, et al. Quality indicators for Barrett’s endotherapy (QBET): UK consensus statements for patients undergoing endoscopic therapy for Barrett’s neoplasia. Frontline Gastroenterology. Published Online First: 14 August 2019. doi:10.1136/flgastro-2019-101247