Original articleAlimentary tractDurability and Predictors of Successful Radiofrequency Ablation for Barrett’s Esophagus
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.
References (24)
- et al.
Prevalence of Barrett's esophagus in the general population: an endoscopic study
Gastroenterology
(2005) - et al.
Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis
Gastrointest Endosc
(2008) - et al.
The role of radiofrequency ablation in the management of Barrett's esophagus
Gastrointest Endosc Clin N Am
(2011) - et al.
Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 10 cm
Gastrointest Endosc
(2011) - et al.
Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett's esophagus with early neoplasia
Clin Gastroenterol Hepatol
(2010) - et al.
Durability of radiofrequency ablation in Barrett's esophagus with dysplasia
Gastroenterology
(2011) - et al.
Efficacy and durability of radiofrequency ablation for Barrett's esophagus: systematic review and meta-analysis
Clin Gastroenterol Hepatol
(2013) - et al.
Remission of Barrett's esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study
Gastroenterology
(2013) - et al.
Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry
Gastroenterology
(2013) - et al.
Observer variation in the diagnosis of dysplasia in Barrett's esophagus
Hum Pathol
(1988)
Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation
Hum Pathol
Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study
Gut
Cited by (102)
Utility and Cost-Effectiveness of a Nonendoscopic Approach to Barrett's Esophagus Surveillance After Endoscopic Therapy
2022, Clinical Gastroenterology and HepatologyDurability of Cryoballoon Ablation in Neoplastic Barrett's Esophagus
2022, Techniques and Innovations in Gastrointestinal EndoscopyCitation Excerpt :Similarly, in a mixed cohort of 54 Dutch patients with neoplastic BE treated with EMR followed by RFA in 4 consecutive cohort studies and followed up to 5 years, the rate of recurrence of dysplasia was 10%.30 However, the United States RFA registry including 1634 patients reported a rate of IM recurrence close to 20% after a median follow-up of 2.4 years.13 The rate of recurrence per 100 person-years ranges from 1.8 to 2.0 for dysplasia, and 5.2 to 9.5 for IM.12,31
Barrett's Epithelial Thickness, Assessed by Volumetric Laser Endomicroscopy, Is Associated With Response to Radiofrequency Ablation
2021, Clinical Gastroenterology and HepatologyClinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett's esophagus
2021, Gastrointestinal EndoscopyCitation Excerpt :The rates of both recurrent IM and dysplasia are within reported ranges from other cohort studies.8-10,13 The finding that older age and longer original BE length are independent predictors of recurrent dysplasia is also consistent with prior work, enhancing the generalizability of the findings.9,25 The current study does have certain limitations, such as the absence of protocolized treatment and sampling and the nonrandomized treatment assignment for recurrent GEJIM.
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.