(NICE) in the United Kingdom (UK) approved the use of Radiofrequency ablation (RFA) as minimally invasive endoscopic therapy for the treatment of Barrett's Oesophagus related neoplasia as an alternative to surgery in 2010. These high risk patients carry a 40-60% risk of progressing to Osophageal Adenocarcinoma (OAC), survival from which is poor. Over the past 5 years combined endoscopic mucosal resection (EMR) and RFA have become the preferred intervention for the curative treatment of patients with BE related neoplasia. Methods We report prospective data from one of the UK's largest academic tertiary centres for patients undergoing RFA for early neoplasia arising in BE between 2008-2013 at University College Hospital, London. Before RFA, visible lesions were removed by EMR. Patients then underwent RFA every 3 months until all visible BE was ablated or cancer developed (endpoints). Biopsies were taken at 12 months or when endpoints reached. Primary outcomes were clearance for dysplasia (CR-D) and BE and intestinal metaplasia (CR-IM) at 12 months. Long term durability for CR-D for those with favourable outcomes at 12 months was assessed. Results Two hundred patients have undergone RFA since 2007 at our centre. Of these 145 have completed treatment. Most are male (83%), mean age 69 years (range 44-91). Baseline histology HGD in 86% and IMC in 14%. Mean length BE segment prior to RFA 6cm (range 1-20). Ten per cent patients in our cohort underwent RFA for residual neoplasia after unsuccessful Photodynamic therapy (PDT). Prior to RFA treatment, 50% of patients had EMR for visible lesions. After 2-3 RFA treatments (range 1-6) over 12 months, 80% (116/45) patients had achieved CR-D and 65% CR-IM (94/145). Pre-treatment PDT, EMR or histology did not influence outcomes. Three patients (2.5%) progressed to invasive OAC at 12 months and in total 8 (7%) progressed at most recent follow up. At 5 years 95% of patients who had dysplasia clearance at 12 months remain disease free (median follow up 20 months, IQR 9-32). Kaplan Meir survival statistics demonstrate at 5 years after successful treatment 75% and 77% of patients are likely to remain free of dysplasia and IM respectively. Conclusion We report on the UK's single largest prospective series to date of patients undergoing endoscopic therapy for BE related neoplasia. Our outcomes compare favourably with those published around the world and from within the UK patient registry. These patients are high risk and require vigilant follow up even after successful treatment as predicted recurrence can occur in up to 25% of cases.
beneficial. With its diagnostic and therapeutic capability DBE should be contemplated in small bowel disease in the setting of a multidisciplinary approach. Results Twenty-eight patients presented at a median age of 67.5 years. The median blood transfusion requirement per patient from symptom presentation to diagnosis or census was 26 units. Anti-platelet and anticoagulation therapy was taken by 50% patients. Twenty-four had diagnoses made (21 small and 3 large intestinal). These included angioectasias in 8 patients (6 small and 2 large bowel) who were >65 years and six of whom were taking anti-platelet therapy for cardiac disease; portal hypertensive enteropathy/ small bowel varices in four patients who were <60 years; and small intestinal tumours in 5 patients (2 gastrointestinal stromal tumours and 3 carcinoid tumours), the latter of which needed surgery for diagnosis and treatment in all cases. Repeat gastroscopy allowed histoacryl glue injection of peri-anastomotic varices in one case and repeat colonoscopy permitted treatment of angioectasias in two elderly patients. Radionuclide red cell scans had the highest radiological diagnostic yield (51%) but were beneficial only in conjunction with other tests. CT angiography (diagnostic yield 30%) resulted in successful angiographic embolisation in 3/9 cases (a small intestinal angioectasia and bleeding associated with colonic diverticula and a pancreaticoduodenal artery pseudoaneurysm). Capsule endoscopy had the highest endoscopic diagnostic yield (53%). In two patients repeat examination was diagnostic (an angioectasia and a gastrointestinal stromal tumour). Antegrade double balloon enteroscopy had the best enteroscopic yield (31%). In 2 cases it allowed argon plasma coagulation of small intestinal angioectasias, which were missed by prior enteroscopy. Surgery had a diagnostic and therapeutic yield of 60%. Introduction Peutz-Jeghers syndrome (PJS) causes multiple hamartomatous polyp formation throughout the gastrointestinal tract. Large polyps within the small bowel (SB) may cause complications and morbidity including obstruction, bleeding, an increased risk of cancer and post surgical adhesional disease. Regular surveillance and removal of large polyps are important to prevent complications from occurring. Methods The aim of our study was to assess the utility of SB capsule endoscopy (SBCE) compared with MR enterography (MRE) for the detection of small bowel PJS polyps.We performed a retrospective review of all adult PJS patients under the care of the St Mark's Polyposis Registry between 2006-2012. Participants' MRE and SBCE findings, enteroscopy reports and case notes were reviewed. Polyps >10 mm were regarded as clinically relevant. Large polyps (>15mm) resected at push enteroscopy (PE), double balloon enteroscopy (DBE) or intraoperative enteroscopy (IOE) were correlated in terms of size, location, number and need for resection with both MRE and SBCE findings. Results 95 patient episodes involving 83 patients (median age 38yrs, 60% female) were included. SBCE...
oesophagus, 4 of 7 (57.1%) oesophageal squamous lesions and 6 of 39 (15.3%) gastric lesions. All patients were discussed at a multidisciplinary meeting and those patients who were fit were offered radical surgery or chemoradiotherapy. Six patients who were offered radical surgery opted for conservative management with endoscopic follow-up. 14 patients proceeded to radical surgery; six of these had no residual cancer in surgical specimen and eight had residual cancer present. 11 of the 14 are currently in disease free survival, two died of recurrence and one died of post-operative complications. Two patients received radical chemoradiotherapy; one is in disease free survival, the other died of advanced adenocarcinoma. One patient received radical radiotherapy and remains free of recurrence. Nine patients received conservative/endoscopic management; of these seven had disease free survival, two died of metastatic adenocarcinoma. Mean follow-up was 32 months. Conclusion Our results show that submucosal invasion is found in a significant proportion of patients undergoing upper gastrointestinal ER. Management of SM invasive cancer following ER remains challenging and our series shows a wide variation in management outcomes. Further research to guide the optimum management of this group of patients is required.
BSG abstracts standards and evaluation in-vivo is required before these PS can be used. However when translated, they may provide more effective PDT in the clinic than current minimally invasive strategies for GI cancers, and offer therapy to more deeply infiltrating tumours. Disclosure of Interest None Declared.
BSG abstracts Methods Patients were identified and recruited from 185 sites (130 UK). Inclusion criteria included normal renal function prior to commencing 5-ASA, ≥50% rise in creatinine after starting 5-ASA and medical opinion implicating 5-ASA justified drug withdrawal. An adjudication panel assessed causality from case report forms using the validated Liverpool Adverse Drug Reaction Causality Assessment Tool. Results 154 patients were recruited. 19 patients were excluded following adjudication. The cohort included patients with Crohn's disease, ulcerative colitis and indeterminate colitis (42%, 55%, 4% respectively). 74% of cases were male. Nephrotoxicity was seen with all aminosalicylates including 1 patient treated with topical therapy only. Nephrotoxicity occurred at a median age of 36.5 yrs (range 15.4-88.4 yrs). Two patients had a confirmed family history of 5-ASA-induced nephrotoxicity. 78% were detected by routine blood monitoring. Only 45% of cases recovered completely after drug withdrawal, with 18 requiring renal replacement therapy (14 transplantation). The median time for peak creatinine after commencing 5-ASA was 3.5 yrs (range 0.16-43.4 yrs). There was no evidence that time on 5-ASA treatment was associated with a higher peak creatinine or the likelihood of full recovery (p = 0.87). Women were more likely to reach full recovery than men (p = 0.00148; OR 8.26; CI 2.46-34.94). There was no evidence that early withdrawal of 5-ASA led to a higher likelihood of complete recovery. There was no difference in recovery between the three disease groups on logistic regression analysis. Conclusion This is the largest and most detailed study of 5-ASA induced nephrotoxicity to date. Whilst the incidence is low, the morbidity is high with 13% of patients requiring renal replacement therapy and 55% of patients failing to return to a normal creatinine after 5-ASA withdrawal. The next step is to carry forward these patients to a genome-wide association analysis, to be performed in February 2013.
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