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Introduction In the UK, radiofrequency ablation (RFA) is established as treatment of choice for flat oesophageal neoplasia or after removal of focal lesions by endoscopic mucosal resection (EMR) to eradicate Barrett’s mucosa. Standard practice is treatment with the HALO 360 Express RFA catheter. A specific complication of RFA is oesophageal stricture development. The UK national RFA registry has quoted a 11–17% rate of strictures requiring dilatation, with higher rates in patients treated with 12J rather than 10J paired ablations(p Methods In December 2017, we adapted our practice to include irrigation with 30cc normal saline between 10J ablations as a cooling phase during the HALO 360 express procedure and removed the cleaning phase between ablations. We have audited patient and disease demographics and outcomes data, especially oesophageal stricture rate, for all patients who had first HALO 360 express between 1/12/16-1/12/18 in our hospital. This represents 12 months before and after technique modification. Statistical analysis of variables was calculated using fisher’s exact test, Wilcoxon ranksum, and logistic regression analysis. Results In the capture period, 36 patients had standard treatment, and 48 patients underwent modified technique. In the latter group, a significantly longer mean Barrett’s segment was treated (6.1 cm vs 8.2 cm; p=0.01). We identified a stricture rate of 22.2% (8/36) in the standard treatment group, and 4.2% (2/48) in the modified group (p=0.014). Stricture rate was significantly higher (p=0.026) with increasing Prague circumferential and maximum Barrett’s length (p=0.023). There was no statistical difference in stricture rate when prior EMR or degree of dysplasia was considered. A logistic regression model showed 85% reduced odds of stricture using the modified treatment (p=0.036) after adjusting for age, procedure type, grade of dysplasia, prior EMR, and Prague measurements. Conclusions Our audit demonstrates an improved outcome with the novel treat-cool-treat technique, with significantly lower rate of stricture development with this modified practice. This has an important bearing on patient care, as dilatation carries its own risk of complication. These findings suggest a benefit to the use of this novel adaptation of standard HALO 360 RFA treatment in Barrett’s neoplasia. |
