Su1111 EFFECTIVENESS AND DURABILITY OF ENDOSCOPIC ERADICATION THERAPY (EET) WITH ENDOSCOPIC MUCOSAL RESECTION (EMR) IN A LARGE MULTICENTER COHORT: THE TREAT-BE CONSORTIUM

Multimodality EET including EMR for all visible lesions (no matter how subtle) followed by ablation is the standard of care for treatment of Barrett’s Esophagus associated neoplasia (BE-AN). Following resection of visible lesions, ablation of the remaining disease is essential to achieve durable eradication of intestinal metaplasia. Despite these recommendations, outcomes data in large volume multicenter cohorts evaluating effectiveness, durability, and adverse events of multimodality EET are limited. To identify effectiveness, as defined by the rate of complete eradication of dysplasia (CE-D) and metaplasia (CE-IM), durability as defined by rates of recurrence of metaplasia (R-IM) and dysplasia (R-D), and safety as defined by adverse events, in a large multicenter cohort of patients with BE who underwent multimodality EET for BE-AN. We performed a multicenter retrospective study involving four tertiary care medical centers (The TREAT-BE Consortium). An existing database of over 2000 patients was reviewed and patients with BE who underwent EMR followed by RFA were included. Data extracted includes: baseline demographics, procedural characteristics, histology, and outcomes data. Multivariate analysis was performed to identify predictors of CE-IM, CE-D, R-IM, and R-D. A total of 508 patients with a mean follow up of 5.6 ± 2.9 years were identified and underwent a total of 720 EMR procedures (Table1). The majority of patients were Caucasian (86.0%) and male (82.2%) with 71.1% patients referred for histology of high-grade dysplasia or intramucosal cancer. CE-IM was achieved in 94.1% (n=319), with 169 patients still undergoing treatment. The rate of CE-D in this cohort was 96.5% (n=365) with 130 patients still undergoing treatment. The mean number of EET sessions required to reach CE-IM was 3.3 ± 2.6. The rates of R-IM and R-D were 15.1% (n=65) and 8.1% (n=34), respectively. The most common adverse events were minor bleeding (16.6%) and esophageal strictures (8.3%). Multivariate analysis identified no significant predictors of CE-IM, CE-D, R-IM, and R-D. Multimodality EET is safe, effective, and durable for treatment of BE-AN. These data validate the current standard of care of endoscopic resection for visible lesions followed by ablative therapy as supportedby published guidelines and proposed quality metrics.Tabled 1Baseline demographics and procedural characteristics for patients undergoing EET for Barrett’s associated neoplasia% (n/N)RaceAfrican American0.4% (2/503)Asian0.8% (4/503)Caucasian86.0% (430/503)Hispanic3.0% (15/503)Other10.0% (5/503)Unknown8.8% (44/503)Surgical historyFundoplication7.7% (37/483)Esophagectomy1.7% (8/482)MedicationsH2 blocker6.3% (29/463)PPI91.4% (436/477)Endoscopic resectionBand60.8% (438/720)Cap52.2% (376/720)Multiple techniques48.1% (346/720)EMR pathologyNo IM10.9% (77/706)IM17.4% (123/706)LGD11.2% (79/706)HGD31.0% (219/706)Cancer - mucosal21.7% (153/706)Cancer - submucosal6.8% (48/706)Cancer - other1.0% (7/706)Adverse eventsMinor bleeding16.6% (119/715)Stricture8.2% (59/715)Perforation1.1% (8/715)Total23.3% (167/715) Open table in a new tab Tabled 1Effectiveness and Durability of Multimodality EET in patients with Barrett’s associated neoplasia% (n/N)CE-IM94.1% (319/329)CE-D96.5% (358/371)R-IM15.1% (65/430)R-D8.1% (34/419) Open table in a new tab