Better Outcomes for Barrett’s Patients
Clinical outcomes of patients undergoing endoscopic therapy for Barrett’s esophagus-related neoplasia have improved significantly over the past 6 years, researchers report from the UK.
Barrett’s esophagus-related neoplasia has a risk of progressing to adenocarcinoma of up to 60%. If detected early, the cancer can be treated, most commonly by endoscopy. Endoscopic mucosal resection (EMR) is performed before radiofrequency ablation (RFA). EMR is performed to remove visible lesions, and then RFA destroys cancer cells in the remaining flat tissue.
An analysis of data from a UK RFA Registry, initiated in 2008 to follow outcomes of patients undergoing endoscopic therapy, reported improved lesion recognition and aggressive resection of visible lesions in the journal Gut online December 24.
Rehan Haidry et al (University College London) examined data collected from the UK registry of patients undergoing RFA and EMR for BE-related neoplasia, comparing outcomes of 266 patients treated from 2008 to 2010 with those of 242 patients treated from 2011 to 2013. The primary outcome was no evidence of dysplasia in a biopsy of the treated segment.
The found that clearance of dysplasia increased from 77% to 92% and clearance of BE increased from 56% to 83% over these time periods. EMR for visible lesions prior to RFA increased from 48% to 60%, and rescue EMR after RFA decreased from 13% to 2%. However, progression to esophageal adenocarcinoma at 12 months did not improve significantly (3.6% vs 2.1%).
The findings are an advance on those published in 2013 in Gastroenterology, reporting that 12 months after treatment, dysplasia was cleared from 81% of patients treated with EMR and RFA (see figure).
“There has been a paradigm shift in our management of Barrett’s high-grade dysplasia and early cancer from surgical treatment to endoscopic treatment,” Prateek Sharma (University of Kansas School of Medicine) told Medscape Medical News.
The use of EMR followed by RFA to treat BE-related neoplasia has increased due to the risks of surgery and the safety and efficacy of endoscopy. Specifically, the morbidity risk of esophagectomy is up to 40%, and the mortality risk is 2% to 4% for all diagnoses, and less than 1% for high-grade dysplasia.
“The data from this registry confirm that a large proportion of patients are being treated with endoscopic therapy, and over time, the results are improving. This is probably related to better recognition of subtle neoplastic lesions, early detection, judicious use of EMR, and improved physician techniques. Endoscopic therapy for this patient group should be main line treatment,” Sharma told Medscape Medical News.
The British Society of Gastroenterology recently released guidelines recommending that patients with BE-related neoplasia and disease confined to the mucosa (T1a) be offered endoscopic therapy as first-line treatment.