Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2015; 7(1): 66-72
Published online Jan 16, 2015. doi: 10.4253/wjge.v7.i1.66
Treatment of dysplastic Barrett’s Oesophagus in lower volume centres after structured training
Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Rob Goldin, Jonathan Hoare
Georgina Chadwick, Jack Faulkner, Robert Ley-Greaves, Panagiotis Vlavianos, Jonathan Hoare, Department of Gastroenterology, St Marys Hospital, W2 1NY London, United Kingdom
Rob Goldin, Department of Histopathology, St Marys Hospital, W2 1NY London, United Kingdom
Author contributions: Hoare J designed the study; Vlavianos P and Hoare J performed all the endoscopies, and collected all the specimens; Goldin R analysed all the specimens; Chadwick G, Faulkner J and Ley-Greaves R extracted all the results from the endoscopy database for analysis; Chadwick G wrote the manuscript with input from Faulkner J and Ley-Greaves R; the manuscript was critically reviewed and edited by Hoare J, Vlavianos P and Goldin R; all authors approved the final manuscript.
Ethics approval: The study was a retrospective observational study and as such did not require review and approval by the Institutional Review board.
Informed consent: The study was a retrospective observational study using routinely collected hospital data, and as such did not require informed consent.
Conflict-of-interest: The research received no specific grant from any funding agency, in the public, commercial, or not-for-profit services. Georgina Chadwick, Panagiotis Vlavianos, Rob Goldin and Jonathan Hoare are employees of imperial College NHS Trust.
Data sharing: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Georgina Chadwick, Department of Gastroenterology, St Marys Hospital, Praed St, Paddington, W2 1NY London, United Kingdom. gchadwick@rcseng.ac.uk
Telephone: +44-020-78696630 Fax: +44-020-78696644
Received: August 28, 2014
Peer-review started: August 30, 2014
First decision: November 3, 2014
Revised: November 10, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: January 16, 2015
Processing time: 139 Days and 20.6 Hours
Abstract

AIM: 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.

CONCLUSION: With structured training good outcomes can be achieved in low volume centres treating dysplastic Barrett’s Oesophagus.

Keywords: Barrett’s Oesophagus; Oesophageal cancer; Endoscopic treatment; Radiofrequency ablation; Endoscopic resection

Core tip: With structured training endoscopic treatment of dysplastic Barrett’s Oesophagus with endoscopic resection and radiofrequency ablation can be provided in lower volume centres with good safety and efficacy outcomes.