title: Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrett's esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry.
abstract: OBJECTIVE
  Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early neoplasia increasingly receive endoscopic mucosal resection and radiofrequency ablation (RFA) therapy. We analyzed data from a UK registry that follows the outcomes of patients with BE who have undergone RFA for neoplasia.
  
  
  METHODS
  We collected data on 335 patients with BE and neoplasia (72% with HGD, 24% with intramucosal cancer, 4% with low-grade dysplasia [mean age, 69 years; 81% male]), treated at 19 centers in the United Kingdom from July 2008 through August 2012. Mean length of BE segments was 5.8 cm (range, 1-20 cm). Patients' nodules were removed by endoscopic mucosal resection, and the patients then underwent RFA every 3 months until all areas of BE were ablated or cancer developed. Biopsies were collected 12 months after the first RFA; clearance of HGD, dysplasia, and BE were assessed.
  
  
  RESULTS
  HGD was cleared from 86% of patients, all dysplasia from 81%, and BE from 62% at the 12-month time point, after a mean of 2.5 (range, 2-6) RFA procedures. Complete reversal dysplasia was 15% less likely for every 1-cm increment in BE length (odds ratio = 1.156; SE = 0.048; 95% confidence interval: 1.07-1.26; P < .001). Endoscopic mucosal resection before RFA did not provide any benefit. Invasive cancer developed in 10 patients (3%) by the 12-month time point and disease had progressed in 17 patients (5.1%) after a median follow-up time of 19 months. Symptomatic strictures developed in 9% of patients and were treated by endoscopic dilatation. Nineteen months after therapy began, 94% of patients remained clear of dysplasia.
  
  
  CONCLUSIONS
  We analyzed data from a large series of patients in the United Kingdom who underwent RFA for BE-related neoplasia and found that by 12 months after treatment, dysplasia was cleared from 81%. Shorter segments of BE respond better to RFA; http://www.controlled-trials.com, number ISRCTN93069556.
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Rehan J
authors.initials: RJ
authors.lastname: Haidry
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Dunn
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Butt
authors.affiliation: Department of Biostatistics, University College London, London, United Kingdom.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Burnell
authors.affiliation: GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Gupta
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Green
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom.
authors.forename: Haroon
authors.initials: H
authors.lastname: Miah
authors.affiliation: Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Smart
authors.affiliation: Princess Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom.
authors.forename: Lesley Ann
authors.initials: LA
authors.lastname: Smith
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Willert
authors.affiliation: Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Grant
authors.initials: G
authors.lastname: Fullarton
authors.affiliation: Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Morris
authors.affiliation: Addenbrookes Hospital, Cambridge, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Royal Infirmary Edinburgh, Edinburgh, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Penman
authors.affiliation: Gloucestershire Hospital NHS Trust, Gloucestershire, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Barr
authors.affiliation: Southampton University Hospital, Southampton, United Kingdom.
authors.forename: Praful
authors.initials: P
authors.lastname: Patel
authors.affiliation: Southampton University Hospital, Southampton, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Boger
authors.affiliation: Aintree University Hospital, Liverpool, United Kingdom.
authors.forename: Neel
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Brinder
authors.initials: B
authors.lastname: Mahon
authors.affiliation: St Mary's Hospital NHS Trust, London, United Kingdom.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Hoare
authors.affiliation: St James Hospital, Dublin.
authors.forename: Ravi
authors.initials: R
authors.lastname: Narayanasamy
authors.affiliation: St James Hospital, Dublin.
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
authors.affiliation: Norfolk and Norwich University Hospital, Norwich, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Cheong
authors.affiliation: Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Direkze
authors.affiliation: Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, United Kingdom.
authors.forename: Yeng
authors.initials: Y
authors.lastname: Ang
authors.affiliation: GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Novelli
authors.affiliation: GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Banks
authors.affiliation: National Medical Laser Centre, University College London, London, United Kingdom; GI Services, University College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: l.lovat@uclh.nhs.uk.
authors.forename: Laurence Bruce
authors.initials: LB
authors.lastname: Lovat
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009367:Neoplasm Staging; D012042:Registries; D016896:Treatment Outcome