TBA (26S144)

Multi-centre analysis on Complicated Barrett’s lesions and subsequent Endoscopic Eradication Therapy

Author(s)

Lloyd, A(1); Hanly, M(3); McDonald C(2); Moran, C(2); Murphy T(2); Carroll, P(1); Collins, C(1); Lee, J(1); Molly, N(3); Cheriyan, D(3); Buckley, M(2); Slattery, E(1).

Department(s)/Institutions

1. Galway University Hospital. 2. Mercy University Hospital. 3. Beaumont University Hospital.

Introduction

Endoscopic eradication therapy (EET), combining endoscopic mucosal resection (EMR) with radiofrequency ablation (RFA), is the preferred treatment for complex Barrett's lesions, aiding diagnosis, staging and eradication of mucosal dysplasia/neoplasia with proven efficacy and favourable safety profile. This service is largely provided by a central specialised hospital, however multiple medium-volume tertiary regional centres in Ireland provide complex EET services to patients with success.

Aims/Background

We aim to review EMR for Barrett’s-related lesions and subsequent confirmatory Barrett’s eradication rates post-EET across medium-volume tertiary referral centres in Ireland.

Method

Retrospective review included Barrett's patients undergoing initial EMR for visible lesions. All patients with prior EET history were excluded. The study assessed Post-EMR histology, R0-resection rates in intra-mucosal carcinoma (IMC), post-EET histological clearance, index diagnosis to EET-clearance duration and complication rates.

Results

104 patients (91 male; 13 female; median age: 72) were eligible recruited from Mercy, Galway and Beaumont University Hospitals. 100% had dysplastic/neoplastic histology (8.5% low-grade dysplasia (LGD); 42.9% high-grade dysplasia (HGD); 47.6% IMC (pT1a: 43.8%; pT1b: 3.8%). 89.4% achieved R0-resection post EMR. 7.7% had positive deep margins (8 patients: HGD: 3; pT1a: 4; pT1b: 1; Unclear: 2). 79 (75.9%) of patients underwent RFA post-EMR. EET-clearance in patients post-RFA was 60.7%. Median time from EMR to EET clearance was 24 months. Procedure-related complication rate was 22.8% (Stricture: 9.5%; intra-procedural bleeding: 7.9%; 3.8% ulceration; 1.6% mucosal tear).

Conclusions

EMR with subsequent ablation provides high post-EMR clearance rates, leading to complete Barrett’s eradication for the majority of patients within 24 months from index diagnosis, with a favourable safety profile.