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Background and objective: The risk of dysplasia and cancer increases with age in Barrett’s oesophagus. Advanced endoscopic therapy such as endoscopic resection and radiofrequency ablation (RFA) is indicated in dysplasia and intramucosal cancer, but is associated with higher risks in older patients with severe comorbidities. Little guidance is available as to when to stop endoscopic therapy and follow-up. Therefore, we analysed the outcomes of endoscopic therapy in elderly patients (>75 years) in a tertiary centre over the last 15 years in relation to their Charlson Comorbidity score (CSI).

Method: All patients aged >75 years who underwent endoscopic therapy since 2008 were selected from the prospectively maintained database. Their Electronic Patient Record (EPR) was searched to establish patient details and outcomes.

Result: Since 2008, 109 patients aged > 75 years with dysplasia or early Barrett’s cancer underwent advanced endoscopic therapy. The median age was 80 years with a range from 75 to 90 years. Only 19/109 (17%) of patients were female. The majority of patients pre-therapy had high-grade dysplasia (59%) at the time of referral. The median Barrett’s length was C3M5.80/109 (73%) underwent EMR first, 10/109 underwent RFA first (9%) and 19/109 (17%) had APC only. 27% were on anticoagulation with warfarin or a DOAC (direct oral anticoagulant). 19% were on an antiplatelet. In terms of complications following therapy, there were 2 delayed haemorrhages, 1 stricture formation and no perforations.72/109 patients (66%) achieved complete resolution of intestinal metaplasia (CR-IM) and 87/109 (80%) achieved complete resolution of dysplasia (CR-D) in the intention to treat analysis. Of the 4 patients with invasive adenocarcinoma (2 identified pre-therapy and 2 identified post-therapy), 2 patients achieved complete resolution of dysplasia. 31/109 patients died during the 15 years follow-up, with a median survival of 5 years after the start of treatment. Only 2 patients died from oesophageal cancer. The overall all cause mortality was higher in patients with higher Charlson Comorbidity Index score (p= 0.04).

Summary: In elderly patients over 75 years with advanced Barrett’s dysplasia or early cancer, advanced endotherapy and follow-up is safe and effective. It should be considered in the context of patient’s fitness and CCI reflecting life expectancy as well as individual risk of progression to invasive cancer.