Radiofrequency ablation for Barrett’s oesophagus related neoplasia with the 360 Express catheter: initial experience from the United Kingdom and Ireland—preliminary results

• Published in: Surgical endoscopy Vol. 36; no. 1; pp. 598 - 606
• Main Authors: Magee, Cormac G., Graham, David, Gordon, Charles, Dunn, Jason, Penman, Ian, Willert, Robert, Smart, Howard, Ortiz-Fernandez-Sordo, Jacobo, Ragunath, Krish, Everson, Martin, Alzoubaidi, Durayd, Banks, Matthew, Morris, Danielle, Sami, Sarmed, Morris, Allan J., Bhandari, Pradeep, Narayanasamy, Ravi, Di Pietro, Massimiliano, Lovat, Laurence B., Haidry, Rehan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Ablation; Aged; Barrett Esophagus - complications; Barrett Esophagus - surgery; Biopsy; Catheter Ablation - methods; Catheters; Clinical medicine; Dosimetry; Endoscopy; Esophageal cancer; Esophageal Neoplasms - complications; Esophageal Neoplasms - surgery; Esophagoscopy - methods; Gastroenterology; Gynecology; Hepatology; Humans; Ireland; ISRCTN; ISRCTN93069556; Medicine; Medicine & Public Health; Proctology; Surgery; Treatment Outcome; United Kingdom; United Kingdom; Ireland; United Kingdom > UK; Strictures; Early oesophageal neoplasia; Express device; Barrett’s oesophagus; radio-frequency ablation
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-021-08325-0

Background Radio-frequency ablation (RFA) for Barrett’s oesophagus (BE)-related neoplasia is currently used after endoscopic resection of visible neoplasia. The HALO 360 balloon has been used to ablate long segment BE. The Barrx™ 360 Express RFA self-sizing catheter (‘RFA Express’) may potentially allow quicker ablation times and improved treatment outcomes. The aim of this paper is to present real world data on the use of the 360 Express Device. Methods Centres in the UK and Ireland submitted cases where the RFA Express was used. The primary outcome was regression of BE at 3 months. Secondary outcomes were the rate of symptomatic stricture formation and resolution of intestinal metaplasia (CR-IM) and dysplasia (CR-D) at End of Treatment (EoT). Results 11 centres submitted 123 consecutive patients. 112 had a follow up endoscopy. The median age was 67 years (IQR 62–75). 3 dosimetries were used. The mean reduction in Circumferential (C) length was 78% ± 36 and mean reduction in Maximal length (M) was 55% ± 36. 17 patients (15%) developed strictures requiring dilation. There was a higher rate of stricture formation when the 12 J energy was used (p < 0.05). 47 patients had EoT biopsies, 40 (85%) had CR-D and 34(76%) had CR-IM. Conclusions The RFA 360 Express catheter shows reduction in length of baseline BE at 3 months after index treatment, and eradication of intestinal metaplasia and dysplasia at 12 months similar to other studies with earlier devices. It appears that the symptomatic stricture rate is slightly higher than previous series with the HALO 360 catheter. This study was performed as part of the HALO registry and has been approved by the Research Ethics Committee - MREC Number 08/H0714/27 Local project reference 08/0104 Project ID 15,033 IRAS Number 54678 EudraCT 2009-015980-1. Registered on ISRCTN as below: ISRCTN93069556. https://doi.org/10.1186/ISRCTN93069556