Endoscopic eradication therapy improves outcomes in Barrett's Esophagus related neoplasia

In a new study it was shown that the treatment of radiofrequency ablation (RFA) is successful and long-lasting in preventing esophageal cancer. The majority of treatment relapses occur early in the course of treatment and can be effectively treated again. The findings of this study were published in Gastrointestinal Endoscopy Journal.

Long-term evidence on the effectiveness of radiofrequency ablation (RFA) in patients with dysplastic Barrett's esophagus (BE) to prevent esophageal cancer are limited. As a result, Paul Wolfson and colleagues undertook this research to see how effective RFA is in treating esophageal cancer.

Researchers collected data from 2,535 individuals with BE (mean length 5.2cm, range 1-20cm) and neoplasia (20% low-grade dysplasia, 54% high-grade dysplasia, 26% intramucosal carcinoma) who had RFA therapy in 28 UK hospitals for this study. Within two years of initiating RFA therapy, clearance rates of dysplasia (CR-D) and intestinal metaplasia (CR-IM) were measured and a detailed analysis of 1,175 patients was undertaken. Relapses and rates of CR-D (CR-D2) and CR-IM (CR-IM2) following additional therapy were also evaluated. The lack of dysplasia and intestinal metaplasia on samples taken at two consecutive endoscopies validated CR-D and CR-IM.

The results of this study were as follow:

1. The Kaplan Meier (KM) cancer rate was 4.1% ten years after starting treatment, with a crude incidence rate of 0.52 per 100 patient years.

2. After two years of therapy, the CR-D and CR-IM rates were 88% and 62.6%, respectively.

3. At 8 years, KM relapse rates were 5.9% for CR-D and 18.7% for CR-IM, with the majority occurring in the first two years.

4. Two years following retreatment, both may be successfully retreated with CR-D2, 63.4%, and CR-IM2, 70.0%.

5. EMR before RFA raised the likelihood of rescue EMR from 17.2 to 41.7% but had no effect on the rate of CR-D, whereas rescue EMR after RFA lowered CR-D from 91.4 to 79.7% (X2 p0.001).

In conclusion, in the prevention of esophageal adenocarcinoma, RFA therapy for dysplastic BE appears to be successful and long-lasting.

Reference:

Wolfson, P., Ho, K. M. A., Wilson, A., McBain, H., Hogan, A., Lipman, G., Dunn, J., Haidry, R., Novelli, M., Olivo, A., & Lovat, L. B. (2022). Endoscopic eradication therapy for Barrett's Esophagus related neoplasia. A final 10 year report from the United Kingdom National Halo Radiofrequency Ablation Registry. In Gastrointestinal Endoscopy. Elsevier BV. https://doi.org/10.1016/j.gie.2022.02.016