Radiofrequency Ablation for Barrett’s Esophagus: Initial Outcomes From a Center Starting This Treatment Modality
Cowley, Kevin MD; Peter, Shajan MD; Mönkemüller, Klaus MD, PhD; Wilcox, Charles MD, MSPH
Introduction: Radiofrequency ablation (RFA) is an effective and proven therapeutic treatment modality for Barrett’s esophagus (BE). We aim to analyze the initial outcomes of RFA for treatment of dysplastic BE at a center new to this treatment modality.
Methods: A retrospective review of patients undergoing RFA for treatment of Barrett’s was performed. Data including patient demographics, medical history, maximum Barrett’s esophagus (cm), number of RFA sessions, and pre and post histopathology was collected and analyzed. Based on results of endoscopic mucosal biopsy, histopathology was then divided into complete eradication (CE) of dysplasia (CE - D) or intestinal metaplasia (CE - IM). Patients were considered lost to follow-up if post-treatment biopsies were not obtained.
Results: A total of 71 patients (mean age 64 ± 13 years) underwent RFA for BE, the majority white (85%), overweight (mean BMI 29.6), and male (85%). Of 61 records, 52 patients (85%) had a history of gastroesophageal reflux. Before treatment, 43 patients (61%) had low-grade dysplasia (LGD), and 28 patients (39%) had high-grade dysplasia or carcinoma (HGD). 12 patients (17%) were lost to follow-up. For the HGD cohort, CE - IM is 60% and CE - D is 72% (median BE length (M) 5 cm; average of 3.4 ± 1.6 RFA treatment sessions). 28% did not achieve eradication of BE (median BE length (M) 8 cm; average 3.9 ± 1.1 RFA treatments). 10 patients (40%) also underwent endoscopic mucosal resection (EMR), with 8 of these ultimately achieving CE - IM. For the LGD cohort, CE - IM is 65% and CE - D is 88% (median BE length (M) 3 cm; average 3.4 ± 1.5 RFA treatment sessions). 12% did not achieve eradication of BE (median BE length (M) 7 cm; average 5.3 ± 2.2 RFA treatments).
Conclusion: RFA for dysplastic BE is an effective treatment modality associated with a high rate of complete eradication. Outcomes from a center starting an ablation program are comparable to published data from established centers.© The American College of Gastroenterology 2014. All Rights Reserved.