O esophag eal Dysplasia Bristol Royal Infirmary MBoal D Titcomb 2217 Background 513 patients with GORD develop Barretts Oesophagus BO 6486 oesophageal adenocarcinoma OAC develops in BO with BO having 11 fold increase risk of developing OAC ID: 750731
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Slide1
Radiofrequency ablation (HALO) in the treatment of Oesophageal Dysplasia
Bristol Royal Infirmary
M.Boal
, D.
Titcomb
2/2/17Slide2
Background5-13% patients with GORD develop Barrett’s
Oesophagus
(BO)
64-86% oesophageal adenocarcinoma (OAC) develops in BO, with BO having 11 fold increase risk of developing OACRadiofrequency ablation (RFA) is a minimally invasive endoscopic technique to prevent progression of disease requiring oesophagectomySlide3
BackgroundRFA applies bipolar
energy to the oesophageal mucosa
causing coagulative necrosis , eradicating:BO in 66-100% of cases
Dysplastic
BO in 79-100
%T1a (early mucosal cancer) in 81-92% Slide4
NICE guidance
2010
:
Recommend use in dysplastic BO
Use in non-dysplastic BO and squamous dysplasia for research purposes
2014:
Enough evidence for use in low grade dysplasia (LGD) Slide5
RFA is preferred to oesophagectomy or surveillance in high grade dysplasia (HGD) and Barrett’s related OAC confined to mucosa (Grade B recommendation)Post EMR visible flat lesions should be managed with RFA (Grade A recommendation)Follow up endoscopy
The British Society of Gastroenterologists guidanceSlide6
NOGCADespite The BSG/ NICE recommendation
that
RFA should be offered to patients with HGD, Tis/T1a disease, NOGCA data suggests 29.7% are still offered surveillance.Slide7
Aim:Rates of dysplasia progression and regression for patients who underwent radiofrequency ablation (HALO/
Barrx
-Flex)Slide8
Primary outcome: Assess rates of disease regression post index RFA interventionSecondary: Assess rates of disease progression post RFA intervention and complicationSlide9
Method:Single centreRetrospective data extracted from clinical/electronic notes1st data set June 2011- Oct 20142nd data set Nov 2014-Dec 2016Slide10
Results:
1st data 6/2011-10/2014
2nd data 11/2014-12/2016
Total
Patients (n)
31
28
59
BO patients
25
27
52
Squamous dysplasia
6
1
7
Median age (range)
73 years (54-91)
67 years (51-85)
70 years
Median interval index to 1st procedure biopsy (range)
64 days (38-443)
66 day (37-405)
65 daysSlide11
Results
Active follow up
n=4
8
Slide12
ConclusionRFA is less invasive and cost effective compared to alternative treatment (surgery) and i
s
associated with less morbidity and no mortalityRFA is effective, causing disease regression in most cases.RFA may halt or slow progression