Gastroenterology

Gastroenterology

Volume 149, Issue 7, December 2015, Pages 1752-1761.e1
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus

https://doi.org/10.1053/j.gastro.2015.08.048Get rights and content

Background & Aims

Radiofrequency ablation (RFA) is commonly used to treat Barrett’s esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality.

Methods

We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality.

Results

Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA.

Conclusions

Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

Section snippets

US Radiofrequency Ablation Patient Registry

The US RFA Patient Registry is a multicenter study reporting processes and outcomes of care after treatment with RFA for BE at 148 institutions (113 community-based, 35 academic-affiliated). The registry was developed as a research tool to assess clinical outcomes after RFA using the HALO Ablation Systems (Covidien, GI Solutions, Sunnyvale, CA), and was funded by Covidien. The registry did not mandate protocols for care, but provided a suggested protocol for treatment and follow-up of patients

Results

Of 5521 patients who enrolled in the US RFA Patient Registry, 4982 (90%) met inclusion criteria. The remaining 539 (10%) did not undergo a biopsy session following initial treatment, and therefore were not at risk for a cancer diagnosis. These subjects were excluded from the risk analysis. The subjects were predominantly white (95%), male (74%), and had a mean age of 62 years (Table 1). At presentation, the mean BE segment was 4.1 cm, and 2346 (47%) patients had NDBE, 368 (7%) had IND, 1020

Discussion

Alhough the relationship of BE and EAC is well established, the impact of endoscopic therapy for BE on EAC incidence and mortality is not well described. Given that these therapies are performed in an effort to decrease death from cancer, such data are vital. The US RFA Registry was designed to assess rates of EAC incidence and EAC-specific and overall death in a large, primarily community practice-based cohort. In this largest reported cohort of patients treated with RFA for BE, the rate of

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    Conflicts of interest N.J.S. has received research funding from Covidien Medical, CSA Medical, NeoGenomics, Takeda Pharmaceuticals, Interpace Diagnostics, and CDx Medical and is a consultant for Oncoscope. G.T., V.R.M., G.W.C., F.S.C., D.S.C., C.J.L., H.W., K.J.C., B.F.O., R.E.P., A.E., S.K., A.I., and R.I.R. have received research funding from Covidien Medical. W.A.W. has received funding to attend educational events sponsored by Nestlé. The other authors have no conflicts to declare.

    Funding This research was funded by National Institutes of Health grants T32 DK07634 and P30 DK034987 and by GI Solutions, a subsidiary of Covidien.

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