• Rehan J Haidry, Gideon Lipman, Matthew R Banks, Mohammed A Butt, Vinay Sehgal, David Graham, Jason M Dunn, Abhinav Gupta, Rami Sweis, Haroon Miah, Danielle Morris, Howard L Smart, Pradeep Bhandari, Robert Willert, Grant Fullarton, Jonathon Morris, Massimo Di Pietro, Charles Gordon, Ian Penman, High Barr, Praful Patel, Philip Boger, Neil Kapoor, Brinder Mahon, Jonathon Hoare, Ravi Narayanasamy, Dermot O'Toole, Edward Cheong, Natalie C Direkze, Yeng Ang, Andrew Veitch, Anjan Dhar, David Nyalender, Krish Ragunath, Anthony Leahy, Mark Fullard, Manuel Rodriguez-Justo, Marco Novelli, and Laurence B Lovat.
• Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
• Endoscopy. 2015 Nov 1; 47 (11): 980-7.

Background And Study AimMucosal neoplasia arising in Barrett's esophagus can be successfully treated with endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA). The aim of the study was to compare clinical outcomes of patients with high grade dysplasia (HGD) or intramucosal cancer (IMC) at baseline from the United Kingdom RFA registry.Patients And MethodsPrior to RFA, visible lesions and nodularity were removed entirely by EMR. Thereafter, patients underwent RFA every 3 months until all visible Barrett's mucosa was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points were reached.ResultsA total of 515 patients, 384 with HGD and 131 with IMC, completed treatment. Prior to RFA, EMR was performed for visible lesions more frequently in the IMC cohort than in HGD patients (77 % vs. 47 %; P < 0.0001). The 12-month complete response for dysplasia and intestinal metaplasia were almost identical in the two cohorts (HGD 88 % and 76 %, respectively; IMC 87 % and 75 %, respectively; P = 0.7). Progression to invasive cancer was not significantly different at 12 months (HGD 1.8 %, IMC 3.8 %; P = 0.19). A trend towards slightly worse medium-term durability may be emerging in IMC patients (P = 0.08). In IMC, EMR followed by RFA was definitely associated with superior durability compared with RFA alone (P = 0.01).ConclusionThe Registry reports on endoscopic therapy for Barrett's neoplasia, representing real-life outcomes. Patients with IMC were more likely to have visible lesions requiring initial EMR than those with HGD, and may carry a higher risk of cancer progression in the medium term. The data consolidate the approach to ensuring that these patients undergo thorough endoscopic work-up, including EMR prior to RFA when necessary.© Georg Thieme Verlag KG Stuttgart · New York.

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