title: Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry.
abstract: BACKGROUND
  Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.
  
  
  METHODS
  We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated.
  
  
  RESULTS
  508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).
  
  
  CONCLUSIONS
  Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients.
  
  
  BACKGROUND
  ISRCTN93069556.
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Haidry
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Butt
authors.affiliation: Guy's and St Thomas' NHS foundation Trust, London, UK Institute for Cancer Genetics and Informatics, Oslo University, Oslo, Norway.
authors.forename: J M
authors.initials: JM
authors.lastname: Dunn
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lipman
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: H L
authors.initials: HL
authors.lastname: Smart
authors.affiliation: Princess Alexandra Hospital, Portsmouth, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: L
authors.initials: L
authors.lastname: Smith
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester,UK.
authors.forename: R
authors.initials: R
authors.lastname: Willert
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: G
authors.initials: G
authors.lastname: Fullarton
authors.affiliation: Addenbrooke's Hospital, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Royal Bournemouth Hospital, Bournemouth, UK.
authors.forename: C
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Royal Infirmary Edinburgh, Edinburgh, UK.
authors.forename: I
authors.initials: I
authors.lastname: Penman
authors.affiliation: Oesophagogastric Surgery, Gloucestershire Hospital NHS Trust, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Barr
authors.affiliation: Department of Gastroenterology, Southampton University Hospital, Southampton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.affiliation: Digestive Diseases Centre, Aintree University Hospital, Liverpool, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: St Mary's Hospital NHS Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hoare
authors.affiliation: St James Hospital, Dublin, Republic of Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Narayanasamy
authors.affiliation: Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Ang
authors.affiliation: Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Veitch
authors.affiliation: Department of Gastroenterology, Nottingham University Hospital NHS Trust, Nottingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ragunath
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Novelli
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: L B
authors.initials: LB
authors.lastname: Lovat
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: BARRETT'S OESOPHAGUS; ENDOSCOPIC PROCEDURES; OESOPHAGEAL CANCER