Original article
Alimentary tract
Durability and Predictors of Successful Radiofrequency Ablation for Barrett’s Esophagus

https://doi.org/10.1016/j.cgh.2014.04.034Get rights and content

Background & Aims

After radiofrequency ablation (RFA), patients may experience recurrence of Barrett’s esophagus (BE) after complete eradication of intestinal metaplasia (CEIM). Rates and predictors of recurrence after successful eradication have been poorly described.

Methods

We used the US RFA Registry, a nationwide registry of BE patients receiving RFA, to determine rates and factors that predicted recurrence of intestinal metaplasia (IM). We assessed recurrence by Kaplan–Meier analysis for the overall cohort and by worst pretreatment histology. Characteristics associated with recurrence were included in a logistic regression model to identify independent predictors.

Results

Among 5521 patients, 3728 had biopsies 12 months or more after initiation of RFA. Of these, 3169 (85%) achieved CEIM, and 1634 (30%) met inclusion criteria. The average follow-up period was 2.4 years after CEIM. IM recurred in 334 (20%) and was nondysplastic or indefinite for dysplasia in 86% (287 of 334); the average length of recurrent BE was 0.6 cm. In Kaplan–Meier analysis, more advanced pretreatment histology was associated with an increased yearly recurrence rate. Compared with patients without recurrence, patients with recurrence were more likely, based on bivariate analysis, to be older, have longer BE segments, be non-Caucasian, have dysplastic BE before treatment, and require more treatment sessions. In multivariate analysis, the likelihood for recurrence was associated with increasing age and BE length, and non-Caucasian race.

Conclusions

BE recurred in 20% of patients followed up for an average of 2.4 years after CEIM. Most recurrences were short segments and were nondysplastic or indefinite for dysplasia. Older age, non-Caucasian race, and increasing length of BE length were all risk factors. These risk factors should be considered when planning post-RFA surveillance intervals.

Section snippets

United States Radiofrequency Ablation Patient Registry

The US RFA Patient Registry is a multicenter collaboration reporting processes and outcomes of care for patients treated with RFA for BE at 148 institutions in the United States (113 community-based, 35 academic-affiliated institutions). The registry was developed as a research tool to monitor clinical outcomes after RFA using the HALO Ablation Systems (Covidien, GI Solutions, Sunnyvale, CA), and is funded by Covidien. The registry does not mandate protocols for care, but provides a suggested

Results

A total of 5521 patients with BE were enrolled in the US RFA Patient Registry and were treated with RFA. Among these patients, 3728 had biopsy specimens obtained 12 months or more after initiation of RFA therapy. Of these, 3169 (85%) achieved CEIM on biopsy specimens obtained 12 months or more after initial treatment, and 559 (15%) had such biopsy specimens taken but did not achieve CEIM. Of the 3169 who achieved CEIM and had biopsy specimens taken 12 months or more after initial treatment,

Discussion

In our cohort of patients treated with RFA for BE, we investigated the rate of IM recurrence and predictors for recurrence of IM. Of the 1634 subjects included in our analysis, 1300 (80%) maintained CEIM and 334 (20%) had recurrence of IM. Histology at the time of recurrence was NDBE or IND in the vast majority (86%). However, 6% (20 of 334) had histologic disease progression at the time of recurrence. The total length of BE at the time of recurrence (mean, 0.6 cm) was markedly less than

Acknowledgments

The abstract of this work was presented previously in the Presidential Plenary of the AGA on May 18, 2013, in Orlando, FL.

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    Conflicts of interest This author discloses the following: Nicholas Shaheen has received research funding from Covidien Medical, CSA Medical, NeoGenomics, Takeda Pharmaceuticals, and Oncoscope, and is a consultant for Oncoscope. The remaining authors disclose no conflicts.

    Funding This research was supported by the National Institutes of Health (T32 DK07634) and by GI Solutions, a subsidiary of Covidien.

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