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Clinical outcomes for BE neoplasia improved in UK
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Patients undergoing endoscopic treatment for Barrett’s esophagus-related neoplasia have had significant improvements in their clinical outcomes during the past 6 years in the United Kingdom, according to recent study data.
Aiming to determine the long-term clinical efficacy of endoscopic therapy with radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) as a first-line treatment for BE-related neoplasia, researchers evaluated prospective data from the first 508 patients in the UK RFA registry to complete treatment. Further, to determine any change — or factors associated with change — in clinical outcomes during the 6-year period since the registry was founded, the 266 patients treated in the first 3 years (2008-2010) were compared with the 242 treated in the following 3-year period (2011-2013).
The treatment involved removal of visible lesions by EMR before 3-month RFA until all BE was ablated or cancer developed. Overall, 73% of patients were treated for high-grade dysplasia and the rest were treated for intramucosal cancer, except for 3% treated for low-grade dysplasia.
They found that the clearance rate for all dysplasia and all BE increased from 77% and 57% in 2008-2010, respectively, to 92% and 83% in 2011-2013, respectively (P<.0001). EMR for visible lesions before RFA also increased from 48% to 60% (P=.016), and rescue EMR after RFA decreased from 13% to 2% (P<.0001). Progression to esophageal adenocarcinoma at 1 year, however, was comparable between time periods (3.4% vs. 2.1%; P=0.51). Factors associated with increased likelihood of achieving clearance rate for dysplasia included increasing age (OR=1.316; 95% CI, 0.685-2.529), prior EMR (OR=1.358; 95% CI, 0.776-2.337), and shorter baseline BE length (OR=1.103; 95% CI, 1.023-1.19), while rescue EMR reduced the likelihood of successful treatment (OR=0.426; 95% CI, 0.195-0.93).
“Our data demonstrate that clinical outcomes for patients with mucosal BE neoplasia undergoing endoscopic therapy have improved since 2008,” the researchers wrote. “Furthermore, the practice of EMR being more widely used prior to initiating RFA may explain the improved outcomes.”
Disclosure: The researchers report financial ties with BARRX Medical, Covidien and Pentax Medical.
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