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Endoscopy To Treat Barrett’s Oesophagus

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Professor Lovat
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We have done it!

We have done it! After six years, we have shown that our use of endoscopy to treat dysplasia arising in Barrett’s oesophagus not only works, but is getting better!

Our work was published in the premier journal, Gut, on Christmas eve. If you would like to see it, please go to http://gut.bmj.com/content/early/2014/12/24/gutjnl-2014-308501.full where you can read the whole story.

But if you would like it in brief, here goes:

Professor Lovat and Dr Haidry run the UK Barrett’s Oesophagus Registry. We are coordinating almost 30 hospitals around the country to offer our ground breaking minimally invasive therapy using endoscopy to treat patients with dysplasia or early cancer arising in Barrett’s oesophagus. So far over 1200 patients have been entered into the registry. They are all treated for a minimum of one year. To date more than 500 patients have completed that one year and are now in long-term follow-up.

The registry launched early in 2008. It is now in existence for over six years. We analysed the patients treated in the first three years of our registry and compared their outcomes with those of the patients treated in the second three years. All had HALO radiofrequency ablation which was administered during endoscopy on the conscious sedation or light general anaesthesia.

By the end of the year of treatment, 77% of patients were clear of dysplasia (precancerous changes) in the first three years. In second three year cohort however this rose to 92%. Similarly the success in completely eradicating all the Barrett’s oesophagus rose from 56% in the first time period to 77% in the second time period. That is an amazing improvement!

Why is the treatment getting better?

We have been analysing this because it is very important to understand how we can get the best outcomes for our patients. It turns out that if we are able to detect any visible abnormalities before stop the radiofrequency ablation and remove these the outcome appears to be significantly better long-term. In the initial three years we removed visible lesions in just under half of all patients with this rose to almost 2/3 in the second half of the study.

The number of patients who required a rescue endoscopic resection for visible lesions fell from 13% to 2% in the same time period. This suggests very strongly that endoscopic resection is absolutely crucial to excellent long-term outcomes.

Better endoscopic imaging

There is no doubt that the quality of endoscopy is improving. The imaging of the latest generation endoscopes is far superior to that which which was available six or seven years ago. This means that it is now possible to detect much more subtle abnormalities and remove these by endoscopic resection before we embark on radiofrequency ablation. One of the other things we have learnt is that training is all-important. We now run training courses for endoscopist all around the UK and throughout Europe. Our own expertise of course increases over time but we are delighted to share this with our colleagues to make sure that the largest number of people can benefit from these new treatments.

Is surgery a thing of the past for Barrett’s oesophagus? 

We believe that surgery still has a place for a very small number of patients with dysplasia arising within Barrett’s oesophagus. It also has a place for some patients with very early cancer in whom endoscopic treatment can still be very successful. The key is to identify those who will benefit from endoscopy compared to those will need surgery. Once again our own expertise is growing in this area as we see more and more patients.

Please celebrate our achievements with us. Go to our Facebook page and give us a thumbs up! Merry Christmas to all our readers.

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