title: Comparing outcome of radiofrequency ablation in Barrett's with high grade dysplasia and intramucosal carcinoma: a prospective multicenter UK registry.
abstract: OBJECTIVE
  Mucosal neoplasia arising in Barrett's esophagus can be successfully treated with endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA). The aim of the study was to compare clinical outcomes of patients with high grade dysplasia (HGD) or intramucosal cancer (IMC) at baseline from the United Kingdom RFA registry.
  
  
  METHODS
  Prior to RFA, visible lesions and nodularity were removed entirely by EMR. Thereafter, patients underwent RFA every 3 months until all visible Barrett's mucosa was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points were reached.
  
  
  RESULTS
  A total of 515 patients, 384 with HGD and 131 with IMC, completed treatment. Prior to RFA, EMR was performed for visible lesions more frequently in the IMC cohort than in HGD patients (77 % vs. 47 %; P < 0.0001). The 12-month complete response for dysplasia and intestinal metaplasia were almost identical in the two cohorts (HGD 88 % and 76 %, respectively; IMC 87 % and 75 %, respectively; P = 0.7). Progression to invasive cancer was not significantly different at 12 months (HGD 1.8 %, IMC 3.8 %; P = 0.19). A trend towards slightly worse medium-term durability may be emerging in IMC patients (P = 0.08). In IMC, EMR followed by RFA was definitely associated with superior durability compared with RFA alone (P = 0.01).
  
  
  CONCLUSIONS
  The Registry reports on endoscopic therapy for Barrett's neoplasia, representing real-life outcomes. Patients with IMC were more likely to have visible lesions requiring initial EMR than those with HGD, and may carry a higher risk of cancer progression in the medium term. The data consolidate the approach to ensuring that these patients undergo thorough endoscopic work-up, including EMR prior to RFA when necessary.
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Rehan J
authors.initials: RJ
authors.lastname: Haidry
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Gideon
authors.initials: G
authors.lastname: Lipman
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Banks
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Butt
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sehgal
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Graham
authors.affiliation: Department of Gastroenterology, Guy's & St Thomas' NHS foundation Trust, London, United Kingdom.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Dunn
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Rami
authors.initials: R
authors.lastname: Sweis
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Haroon
authors.initials: H
authors.lastname: Miah
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Danielle
authors.initials: D
authors.lastname: Morris
authors.affiliation: Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Smart
authors.affiliation: Solent Centre for Digestive Diseases, Princess Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Department of Gastroenterology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Willert
authors.affiliation: Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Grant
authors.initials: G
authors.lastname: Fullarton
authors.affiliation: Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Morris
authors.affiliation: Department of Gastroenterology, Addenbrookes Hospital, Cambridge, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Department of Gastroenterology, Royal Infirmary Edinburgh, Edinburgh, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Penman
authors.affiliation: Department of Gastroenterology, Gloucestershire Hospital NHS Trust, Gloucester, United Kingdom.
authors.forename: High
authors.initials: H
authors.lastname: Barr
authors.affiliation: Department of Gastroenterology, Southampton University Hospital, Southampton, United Kingdom.
authors.forename: Praful
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Gastroenterology, Southampton University Hospital, Southampton, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Boger
authors.affiliation: Gastrointestinal Unit, Aintree University Hospital, Liverpool, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Brinder
authors.initials: B
authors.lastname: Mahon
authors.affiliation: Department of Gastroenterology, St Mary's Hospital NHS Trust, London, United Kingdom.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Hoare
authors.affiliation: Department of Gastroenterology, St James Hospital, Dublin, Ireland.
authors.forename: Ravi
authors.initials: R
authors.lastname: Narayanasamy
authors.affiliation: Department of Gastroenterology, St James Hospital, Dublin, Ireland.
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
authors.affiliation: Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Cheong
authors.affiliation: Department of Gastroenterology, 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, Manchester, United Kingdom.
authors.forename: Yeng
authors.initials: Y
authors.lastname: Ang
authors.affiliation: Endoscopy and Bowel Cancer Screening, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Veitch
authors.affiliation: Department of Gastroenterology, County Durham Hospital, Durham, United Kingdom.
authors.forename: Anjan
authors.initials: A
authors.lastname: Dhar
authors.affiliation: Department of Gastroenterology, Newcastle-upon-Tyne Hospital, Newcastle-upon-Thyne, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Nyalender
authors.affiliation: Wolfson Digestive Diseases Centre, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.affiliation: Department of Gastroenterology, Watford Hospital, Watford, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Leahy
authors.affiliation: Department of Gastroenterology, Watford Hospital, Watford, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Fullard
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodriguez-Justo
authors.affiliation: Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Novelli
authors.affiliation: Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, United Kingdom.
authors.forename: Laurence 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 / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012042:Registries; D016896:Treatment Outcome; D006113:United Kingdom