Endoscopic eradication therapy for Barrett’s Esophagus related neoplasia. A final 10 year report from the United Kingdom National Halo Radiofrequency Ablation Registry

ABSTRACT

Background and Aims

Long-term durability data for effectiveness of radiofrequency ablation (RFA) to prevent esophageal adenocarcinoma in patients with dysplastic Barrett's esophagus (BE) are lacking.

Methods

We prospectively collected data from 2,535 patients with BE (mean length 5.2cm, range 1-20cm) and neoplasia (20% low-grade dysplasia, 54% high-grade dysplasia, 26% intramucosal carcinoma) who underwent RFA therapy across 28 UK hospitals. We assessed rates of invasive cancer and performed detailed analysis of 1,175 patients to assess clearance rates of dysplasia (CR-D) and intestinal metaplasia (CR-IM) within 2 years of starting RFA therapy. We assessed relapses and rates of return to CR-D (CR-D2) and CR-IM (CR-IM2) after further therapy. CR-D and CR-IM were confirmed by absence of dysplasia and intestinal metaplasia on biopsies taken at two consecutive endoscopies.

Results

Ten years after starting treatment, Kaplan Meier (KM) cancer rate was 4.1% with a crude incidence rate of 0.52 per 100 patient years. CR-D and CR-IM after 2 years of therapy were 88% and 62.6% respectively. KM relapse rates were 5.9% from CR-D and 18.7% from CR-IM at 8 years, with most occurring in the first 2 years. Both could be successfully retreated with CR-D2, 63.4% and CR-IM2, 70.0% two years after retreatment. EMR before RFA increased likelihood of rescue EMR from 17.2% to 41.7%, but did not affect the rate of CR-D, whereas rescue EMR after RFA commenced reduced CR-D from 91.4% to 79.7% (Χ² p<0.001).

Conclusion

RFA treatment is effective and durable to prevent esophageal adenocarcinoma. Most treatment relapses occur early and can be successfully retreated.