Tu1559 Safety of Same-Session Cryotherapy and Esophageal Stricture Dilation in the Treatment of Esophageal Neoplasia- a Multicenter Study

Tu1559 Safety of Same-Session Cryotherapy and Esophageal Stricture Dilation in the Treatment of Esophageal Neoplasiaa Multicenter Study Vladimir M. Kushnir*, Stuart R. Gordon, Steven A. Edmundowicz, Dayna S. Early, Thomas G. Hollander, Michael S. Smith Gastroenterology, Washington University School of Medicine, St. Louis, MO; Temple University School of Medicine, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH Background: Endoscopically delivered spray cryotherapy (SCT) is an emerging treatment modality for the ablation of Barrett’s esophagus and early esophageal cancer. Esophageal strictures are commonly encountered in this patient population; as such, stricture dilation is frequently required in order to reach the treatment area for SCT and/or treat dysphagia. However, it is unknown if performing stricture dilation and using SCT during the same endoscopic session is clinically safe. Aim: To evaluate the safety and feasibility of performing same-session stricture dilation and SCT. Methods: A retrospective cohort study of consecutive patients undergoing same-session esophageal stricture dilation and SCT for the treatment of Barrett’s esophagus or early esophageal cancer at three high volume SCT centers between 2008 and 2014. Demographics, clinical characteristics, procedural details and complications were abstracted from review of the institutional medical records. All data were de-identified prior to aggregation. Results: The cohort was composed of 17 patients [12 male, 5 female, median age 72 years (range 52-91)]. Patients underwent a total of 49 upper endoscopies with same-session stricture dilation and SCT; median of 1 (range 1-11) per patient. The underlying diagnosis was Barrett’s esophagus in 2 cases (1 low grade dysplasia, 1 nondysplastic), invasive esophageal adenocarcinoma in 12 and invasive esophageal squamous cell carcinoma in 3 cases. Strictures were located in the mid-esophagus in 3 cases and the distal esophagus in 14. The median pre-dilation esophageal luminal diameter at the level of the stricture was 11 mm (range 3-15 mm). Stricture dilation was performed prior to SCT in 16 procedures, immediately post SCT in 30, and both pre and post SCT in 3. All dilations were performed using controlled radial expansion balloons; median dilation diameter was 18 mm (range 14-20 mm). A serious post-procedure adverse event occurred in one patient (2%). This patient developed an esophageal micro-perforation; presenting with abdominal and chest pain immediately following endoscopy. The micro-perforation was managed conservatively with parenteral antibiotics and bowel rest; he recovered uneventfully after a 5 day hospital stay. There were no episodes of post dilation bleeding requiring intervention, nor any additional post procedure hospital admissions or delayed adverse events. Conclusion: Same session esophageal stricture dilation and SCT is a safe and well-tolerated strategy for the management of Barrett’s esophagus and esophageal cancer in patients with concomitant esophageal strictures. Tu1560 The Effect of Pre-Treatment Stricture on Outcomes After Radiofrequency Ablation (RFA) for Barrett’s Esophagus: Results From the U.S. RFA Registry Swathi Eluri*, Nan Li, Bergein F. Overholt, Sarina Pasricha, Charles J. Lightdale, Thomas Runge, Anthony Infantolino, W. Asher Wolf, V. Raman Muthusamy, Cary C. Cotton, Ronald E. Pruitt, Nicholas J. Shaheen Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC; Gastrointestinal Associates, Knoxville, TN; Division of Gastroenterology and Hepatology, Columbia University School of Medicine, New York, NY; Division of Gastroenterology, Thomas Jefferson University Medical Center, Philadelphia, PA; Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Division of Gastroenterology, Saint Thomas Hospital, Nashville, TN Background: Barrett’s esophagus (BE) is a premalignant condition characterized by intestinal metaplasia (IM) of the esophagus, which may be eradicated by RFA. There are limited data evaluating the impact of the presence of esophageal strictures prior to ablation on RFA outcomes, including complete eradication of dysplasia (CE-D), complete eradication of IM (CE-IM), or recurrence rates following successful therapy. Methods: The U.S. RFA Registry is a prospective study of BE patients treated with RFA at 148 academic and community institutions. CE-IM was defined as the absence of intestinal metaplasia, and CE-D as absence of dysplasia, from all histologic specimens from the esophagus during an endoscopy, at least 12 months after initial treatment. Recurrence was defined as any biopsy from the esophagus consistent with IM during the surveillance period. Student’s t-test and chi-square test were used to compare the baseline characteristics, efficacy outcomes, and IM recurrence rate between patients with and without strictures before treatment. Multivariate logistical regression and Cox proportional hazards regression were performed after adjusting for age, sex, baseline histology, length of BE segment, and academic vs. private practice setting. Results: Among 5521 patients (27% women; 73% men) who underwent RFA, there were 223 (4%) who had an esophageal www.giejournal.org Vol stricture prior to treatment. Out of those with strictures, 50% had non-dysplastic IM, 7% had indefinite dysplasia, 18% had low-grade dysplasia (LGD), 17% had high-grade dysplasia (HGD), 6% had intramucosal carcinoma (IMC), and 2% had esophageal adenocarcinoma (EAC) (Table 1). Length of BE was longer in patients with strictures (4.8cm vs. 4.1cm, pZ0.01). In patients with strictures (Table 2), CE-IM was achieved in 79 % of patients compared to 86% in patients without strictures (pZ0.01). There was no significant difference in mean number of treatments needed to achieve CEIM. The rates of CE-D were 86% in patients with pre-ablation stricture compared to 94% of those without a stricture (pZ0.01). The adjusted odds of CE-IM (ORZ0.7, 95% CI:0.5-1.1] and CE-D (ORZ0.6, 95% CI: 0.3-1.2], were lower in the pre-treatment stricture group, but no longer significant after adjustment. There was a higher proportion of recurrence in patients with pre-ablation stricture vs. no stricture (20% vs. 13%, pZ0.02). There was no significant difference in mean years to recurrence. The recurrence rate remained higher among patients with a pre-treatment stricture after adjusting for potential confounders (hazard ratioZ1.4, 95%CI: 1.0-2.1). Conclusions: The presence of a pre-ablation stricture increased the likelihood of recurrence of intestinal metaplasia after successful treatment with RFA. BE patients with esophageal strictures may need closer surveillance for disease recurrence. Table 1. Demographics of patients with and without pre-ablation strictures ume 81, No. 5S : 2015 GASTRO Strictures (n[223) INTESTINAL No Strictures (n[5298)