PTU-049 RFA for barrett’s low grade dysplasia: results of the 1st cohort treated in east midlands

IntroductionEndoscopic treatment with radiofrequency ablation (RFA) is the ablative therapy of choice for patients with flat high-grade dysplasia (HGD) and residual Barrett’s oesophagus (BO) after endoscopic mucosal resection (EMR) of visible lesions. The latest BSG guidelines have recommended it for low-grade dysplasia (LGD) as well. We aim to assess safety and effectiveness from the East Midlands Barrett’s RFA database.MethodsAnalysis of a prospectively collected database was performed. All patients who underwent RFA for confirmed LGD on two separate occasions between February 2011 and June 2018 were included for analysis. RFA was performed with either the balloon or focal device or both, depending on Barrett’s length and preferences of the endoscopist. All patients were maintained on high dose twice daily acid suppression with proton pump inhibitors and H2 antagonists for 2 weeks immediate post RFA. Sessions were performed every 3 months until the BO was endoscopically eradicated. Confirmed remission of BO was defined as the absence of dysplasia (CRD) and intestinal metaplasia (CRIM) in all the biopsies taken from the GOJ and original BO length at follow up endoscopy 3 months after the RFA session.ResultsA total of 41 patients were included for analysis (88% male), median age 70 years (mean 66.9). Mean number of RFA sessions per patient was 3.2 (2–6). Average duration of treatment was 38.5 weeks (10–84). 10/41 patients are still undergoing treatment, 28/41 completed RFA protocol and the treatment was discontinued in 3 patients due to histological progression (2 cases) or complication (1 case, complex stricture). 90.3% (28/31) of patients achieved CRD and CRIM at first follow up endoscopy.During RFA treatment, histological progression occurred in 6 patients (14.6%): HGD=4 and adenocarcinoma=2. Treatment for HGD was EMR followed by RFA in 3 and RFA alone in 1 patient without visible lesion. The 2 patients with adenocarcinoma required curative surgery.Most common complication requiring intervention was oesophageal stricture in 17.1% (7/41 patients). All successfully managed with endoscopic dilatation but RFA was abandoned in 1 patient.ConclusionsRFA for LGD is safe and has a high success rate. However, a higher incidence of post RFA strictures was observed in this study that requires investigating. Progression to HGD or cancer was seen in almost 15% of patients, which highlights the importance of offering treatment to this cohort of Barrett’s patients.