Time To Crd And Subsequent Relapses: Ten Year Follow Up From The Uk Patient Registry

Background Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are first line therapy for patients with dysplastic Barrett’s oesophagus (BE) or intramucosal carcinoma (IMC) to prevent oesophageal adenocarcinoma (OAC). We analysed patient outcome using 10 year data from the UK RFA registry. Methods Prospective data was collected from patients undergoing RFA ± EMR from 2008. All patients gave written informed consent. Only data reviewed by the primary coordinating centre was included. Kaplan Meier (KM) and log rank analysis were performed with Microsoft Excel and R Studio software. We included 1299 patients from 10 centres. 82% were male,median age 68 yrs (IQR 61.5 to 74.4 yrs). Patients were excluded if not followed up for a minimum of 18 months or recruited after 1 January 2018. CRD-1 was defined as initial clearance of dysplasia. If a patient relapsed and dysplasia was successfully cleared a second time, this was termed CRD-2. Results Using KM analysis the proportion of patients of the total cohort (n=1299) who achieved CRD-1 at two endoscopies was 55% at 1 year (n=716), 81% at 2 years (n=1056) and 89% at 5 years of continuous therapy (n=1118). Median time to CRD-1 was 296 days (IQR 183–414). The KM proportion of relapse after CRD-1 was 4% at 1 year (n=50), 10% at 2 years (n=113), 18% at 5 years (n=170) and 22% at 10 years (n=179). Median time to relapse was 567 days (IQR 357–995). Of 170 patients that relapsed from CRD-1 only 86 patients achieved CRD-2 (50.6%). Of these 29 required a single treatment. For the remainder median time to CRD-2 was 145 days (IQR 84–250). A total of 46/1312 (3.5%) patients developed invasive OAC; 16 were patients that achieved CRD-1. The majority (56%) of these 16 patients relapsed within the first 2 years following CRD-1. Of the patients that achieved CRD-1 the KM risk of developing invasive OAC over the follow up period was 1.4% compared with 17% for those who never achieved CRD (p Conclusions Successful eradication of dysplastic BE occurs in the vast majority of patients within two years of starting endotherapy. Relapses are rare and usually occur within 2 years of completing therapy. This prospective data adds further evidence to the long term benefit of eradication of dysplastic BE in reducing invasive OAC. Achieving and maintaining CRD in dysplastic BE patients reduces OAC risk to a level similar to patients with non-dysplastic BE.