Survival from EAC is poor. Minimally invasive endotherapy with endoscopic mucosal resection (EMR) and RFA have emerged as alternatives to surgery for the curative treatment selleck kinase inhibitor of patients with Barrett’s related neoplasia. Prospective data from the United Kingdom (UK) HALO RFA registry of patients undergoing RFA for early neoplasia arising in BE.Intervention:

Before RFA, superficial lesions were removed by EMR. Patients then underwent RFA every 3 months until all visible BE was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points reached. If BE or dysplasia recurred, they were ablated at the endoscopist’s discretion. Outcomes: Primary outcomes were clearance for HGD (CR-HGD), all dysplasia (CR-D) & BE (CR-BE) at 12 months. Long term durability for CR-D for those with favorable outcomes at end of protocol was assessed. Predictors of successful outcomes were also examined. 630 patients have consented to have their outcomes recorded. We report on 370 who have completed treatment protocol with 12 month histology. 81% are male, mean age 68 years (40-91). Patient’s underwent a mean of 2.5 ablations (1-6) during PD-0332991 clinical trial treatment protocol. 70% had baseline histology HGD, 27% IMC & 3% LGD. Mean length baseline BE was 5.6cm (1-20).

At 12 months CR-HGD was 87% patients, CR-D 82%, & CR-BE 64%. 97% of those with no dysplasia at 12 months have remained free of disease at most recent follow up (median follow up 18 months, range 2-68). Kaplan Meier survival Chloroambucil statistics predict CR-D is durable at 5 years with 88% remaining disease free. Logistic regression analysis to examine effect of baseline BE length on outcomes

demonstrate that each extra 1 cm of BE reduces the chances of attaining CR D by 15.7% (OR 1.156, SE 0.048, CI 1.07 – 1.26, p=0.0003). Similarly using logistic regression, for each extra RFA treatment the likelihood of CR-D increases by 31.7% (OR=0.683, SE 0.95, CI 0.52 – 0.89, p=0.0006). Rate of progression to invasive cancer at 12 months was 2.7%. Symptomatic strictures requiring dilatation occurred in 9% of cases after treatment. This is the largest series to date of patients undergoing RFA from 19 UK centers. End of protocol CR-D is encouraging at 83% and successful eradication appears to be very durable. Patients with shorter segment BE are likely to respond better, and those who have multiple treatments are more likely to achieve CR-D. Our data represent real life outcomes of integrating minimally invasive endotherapy into demanding endoscopy service commitments. “
“Radiofrequency ablation (RFA) combined with endoscopic mucosal resection (EMR) for visible lesions is shown to be effective in eradicating dysplastic Barrett’s oesophagus (BE) providing a credible alternative to surgery for high grade dysplasia (HGD) and early mucosal cancer (IMC) in BE.