title: Incidence of metachronous visible lesions in patients referred for radiofrequency ablation (RFA) therapy for early Barrett's neoplasia: a single-centre experience.
abstract: OBJECTIVE
  Evaluate the incidence of metachronous visible lesions (VLs) in patients referred for radiofrequency ablation (RFA) for early Barrett's neoplasia.
  
  
  METHODS
  This study was conducted as part of the service evaluation audit.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  All patients with dysplastic Barrett's oesophagus referred for RFA were included for analysis. White light high-resolution endoscopy (HRE), autofluorescence imaging and narrow band imaging were sequentially performed. Endoscopic mucosal resection (EMR) was performed for all VL. Three to six months after EMR, all patients underwent initial RFA and then repeat RFA procedures at three monthly intervals.
  
  
  METHODS
  All endoscopy reports and final staging by EMR/surgery were evaluated and included for analysis.
  
  
  RESULTS
  Fifty patients were analysed; median age 73 years, 84% men. 38/50 patients (76%) had a previous EMR due to the presence of VL before referred for ablation; twelve patients had no previous treatment. In total, 151 ablation procedures were performed, median per patient 2.68. Twenty metachronous VL were identified in 14 patients before the first ablation or during the RFA protocol; incidence was 28%. All metachronous lesions were successfully resected by EMR. Upstaging after rescue EMR compared with the initial histology was observed in four patients (28%).
  
  
  CONCLUSIONS
  In total, 28% of patients enrolled in the RFA programme were diagnosed to have metachronous lesions. This high-incidence rate highlights the importance of a meticulous examination to identify and resect any VL before every ablation session. RFA treatment for early Barrett's neoplasia should be performed in tertiary referral centres with HRE and EMR facilities and expertise.
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK.
authors.forename: J
authors.initials: J
authors.lastname: Ortiz-Fernández-Sordo
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK.
authors.forename: S
authors.initials: S
authors.lastname: Sami
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK.
authors.forename: R
authors.initials: R
authors.lastname: Mansilla-Vivar
authors.affiliation: Digestive Diseases Centre, University Hospitals of Leicester NHS Trust , Leicester , UK.
authors.forename: J
authors.initials: J
authors.lastname: De Caestecker
authors.affiliation: Gastroenterology and Hepatology Department , Derby Hospitals NHS Foundation Trust , Derby , UK.
authors.forename: A
authors.initials: A
authors.lastname: Cole
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK.
authors.forename: K
authors.initials: K
authors.lastname: Ragunath
keywords: BARRETT'S CARCINOMA; ENDOSCOPIC PROCEDURES
references.citation: Am J Gastroenterol. 2013 Feb;108(2):187-95; quiz 196
references.pmid: 23247578
references.citation: Gastrointest Endosc. 2011 Apr;73(4):662-8
references.pmid: 21272876
references.citation: Gastroenterology. 2013 Jul;145(1):96-104
references.pmid: 23542068
references.citation: Gut. 2014 Jan;63(1):7-42
references.pmid: 24165758
references.citation: Endoscopy. 2007 Jul;39(7):588-93
references.pmid: 17611912
references.citation: Gastroenterology. 2006 Nov;131(5):1392-9
references.pmid: 17101315
references.citation: Virchows Arch. 2010 Jun;456(6):609-14
references.pmid: 20449614
references.citation: Best Pract Res Clin Gastroenterol. 2005 Dec;19(6):889-907
references.pmid: 16338648
references.citation: Surg Endosc. 2010 May;24(5):1110-6
references.pmid: 19915911
references.citation: Clin Gastroenterol Hepatol. 2010 Jan;8(1):23-9
references.pmid: 19602454
references.citation: J Gastrointest Surg. 2008 Oct;12(10):1627-36; discussion 1636-7
references.pmid: 18704598
references.citation: Clin Gastroenterol Hepatol. 2014 Mar;12(3):368-76.e1
references.pmid: 23811245
references.citation: N Engl J Med. 2009 Dec 24;361(26):2548-56
references.pmid: 20032324
references.citation: Endoscopy. 2005 Jun;37(6):570-8
references.pmid: 15933932
references.citation: J Pathol. 2005 Jan;205(1):57-64
references.pmid: 15586364
references.citation: Gastroenterology. 2001 Jun;120(7):1630-9
references.pmid: 11375945
references.citation: J Gastrointest Oncol. 2012 Dec;3(4):314-21
references.pmid: 23205307
references.citation: Gastroenterology. 2013 Jul;145(1):87-95
references.pmid: 23542069
references.citation: Pathol Res Pract. 2010 May 15;206(5):300-4
references.pmid: 20188488
references.citation: Clin Gastroenterol Hepatol. 2013 Oct;11(10):1245-55
references.pmid: 23644385
references.citation: Gastroenterology. 1993 Jul;105(1):40-50
references.pmid: 8514061
references.citation: Gut. 2011 Jun;60(6):765-73
references.pmid: 21209124
references.citation: Endoscopy. 2010 Dec;42(12):1030-6
references.pmid: 20960392
references.citation: World J Surg. 2003 Sep;27(9):1052-7
references.pmid: 12917758
references.citation: Am J Gastroenterol. 2000 Aug;95(8):1888-93
references.pmid: 10950031
references.citation: Best Pract Res Clin Gastroenterol. 2008;22(4):687-720
references.pmid: 18656825