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PTH-017 long-term outcomes for RFA in early barrett’s-associated neoplasia – are we succeeding?

Introduction Minimally invasive, endoscopic therapies (radiofrequency ablation (RFA) with/without endoscopic resection (ER)) are widely performed for early Barrett’s-associated neoplasia (dysplasia or intramucosal carcinoma) and appear to be effective in the short term. There is however, a paucity of longer term outcomes including overall survival, in a cohort of patients who are often significantly co-morbid or increasingly elderly. We aim to study and overall survival (OS) in a cohort of patients with early neoplasia in Barrett’s oesophagus (BO-EN) treated since 2008. Methods A retrospective audit of a cohort of patients receiving RFA for BO-EN, of any length, at the Ninewells Hospital and Medical School was analysed. Between December 2008 and January 2018; 39 patients were undergoing/completed treatment and engaged in active surveillance. These patients were assessed for baseline demographics, duration of follow up and mortality, with a future directive being the assessment of complete resolution of both BO-EN and Barret’s Oesophagus – Intestinal Metaplasia (BE-IM). Results In total, we have a completed cohort of 39 patients with absolute dataset who have undergone treatment. Of our population; 27 (69%) are male with the remaining 12 (31%) being female with a median age of 67 (Range 44–82 years). Patients were followed up for a median of 42 months (Range 1–172). A total of 39, 27 and 17 patients were included in the baseline (<1 year post therapy), 3 year and 5 year analyses, respectively. The presenting histology was Low-Grade Dysplasia (LGD) – 8 (21%), High-Grade Dysplasia (HGD)- 22 (56%) and Carcinoma In-Situ – 9 (23%). Overall survival at 1, 3 and 5 years was 100%, with no progression to overt invasive malignancy demonstrated within this populace. Conclusions RFA (with/without ER) appears to be effective at controlling BO-EN and preventing progression to invasive adenocarcinoma, with a sustained effect appreciable to at least 5 years and possibly beyond. Not unsurprisingly men appear to develop higher grades of dysplasia; at younger ages, this is consistent with known risk bias within the published literature (Average age at diagnosis; M=65 years vs F=81). Our data suggests that despite the considerable comorbidity of these individuals, the intervention is well tolerated, with minimal deleterious sequelae and good survival prospects, albeit in a small sample size. We aim to continue to expand the dataset prospectively and actively record the capability for RFA treatment to completely reverse underlying intestinal metaplasia in this group.