title: Treatment of dysplastic Barrett's Oesophagus in lower volume centres after structured training.
abstract: OBJECTIVE
  To investigate whether dysplastic Barrett's Oesophagus can be safely and effectively treated endoscopically in low volume centres after structured training.
  
  
  METHODS
  After attending a structured training program in Amsterdam on the endoscopic treatment of dysplastic Barrett's Oesophagus, treatment of these patients was initiated at St Marys Hospital. This is a retrospective case series conducted at a United Kingdom teaching Hospital, of patients referred for endoscopic treatment of Barrett's oesophagus with high grade dysplasia or early cancer, who were diagnosed between January 2008 and February 2012. Data was collected on treatment provided (radiofrequency ablation and endoscopic resection), and success of treatment both at the end of treatment and at follow up. Rates of immediate and long term complications were assessed.
  
  
  RESULTS
  Thirty-two patients were referred to St Marys with high grade dysplasia or intramucosal cancer within a segment of Barrett's Oesophagus. Twenty-seven met the study inclusion criteria, 16 of these had a visible nodule at initial endoscopy. Treatment was given over a median of 5 mo, and patients received a median of 3 treatment sessions over this time. At the end of treatment dysplasia was successfully eradicated in 96% and intestinal metaplasia in 88%, on per protocol analysis. Patients were followed up for a median of 18 mo. At which time complete eradication of dysplasia was maintained in 86%. Complications were rare: 2 patients suffered from post-procedural bleeding, 4 cases were complicated by oesophageal stenosis. Recurrence of cancer was seen in 1 case.
  
  
  CONCLUSIONS
  With structured training good outcomes can be achieved in low volume centres treating dysplastic Barrett's Oesophagus.
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Georgina
authors.initials: G
authors.lastname: Chadwick
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Faulkner
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Ley-Greaves
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vlavianos
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Rob
authors.initials: R
authors.lastname: Goldin
authors.affiliation: Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hoare
keywords: Barrett’s Oesophagus; Endoscopic resection; Endoscopic treatment; Oesophageal cancer; Radiofrequency ablation