Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: results from the national Dutch database in a 10-year period

Abstract

ObjectiveRadiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DesignEndoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.ResultsAfter ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0–1; 1–2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22–69) and 4 endoscopies (1–5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.ConclusionIn a setting of centralised care, RFA±ER is effective for eradication of Barrett’s related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.Netherlands trial register numberNL7039.

Systematic review with meta‐analysis: the long‐term efficacy of Barrett's endoscopic therapy—stringent selection criteria and a proposal for definitions

“…From these prior attempts, it remains unclear if initial CE‐IM and durable CE‐IM are examined separately. Finally, long‐term follow‐up results of those undergoing radiofrequency ablation was reported by van Munster et al 29 recently; however, we were not able to include this study due to incorporation of subjects with low‐grade dysplasia and submucosal invasive cancer (at least one‐third), inhomogenous ≥2‐year follow‐up, flexible sampling protocol and lack of data on subjects undergoing other forms of BET.…”

Incidence and outcomes of poor healing and poor squamous regeneration after radiofrequency ablation therapy for early Barrett’s neoplasia

“…The overall treatment and follow-up outcomes for this cohort have been published. [9] In summary, the majority was male (81%) with a mean age of 66 years (Table 1). The median BE length at baseline was C2M5 with LGD (27%), HGD (30%), or EAC (43%).…”

“…The BEC registry has been described in detail previously. [9] For the current study, we included all patients with BE containing early neoplasia who underwent endoscopic eradication therapy with at least one RFA treatment between 1-1-2008 and 31- . The treatment and follow-up outcomes for this cohort of patients have been published [9], but the current study analyzed and reported different endpoints.…”

“…The BEC registry has been described in detail previously [9]. For the current study, we included all patients with BE containing early neoplasia who underwent endoscopic eradication therapy with at least one RFA treatment between 1 January 2008 and 31 December 2018.…”

“…An incident lesion occurred in 22% of patients with PSR (16/74), compared to 5% (61/1,245) of patients with normal squamous regeneration (RR 4.4 [95% CI 2.7-7.3]) (Table 2). For patients with PSR, 11/16 (58%) incident lesions were noted to have progressed to advanced neoplasia, compared to 6/61 incident lesions (10%) among patients with normal squamous regeneration (RR 7.0 [95% CI [3][4][5][6][7][8][9][10][11][12][13][14][15][16]).…”