Clinical Outcomes Following Recurrence of Intestinal Metaplasia after Successful Treatment of Barrett's Esophagus with Radiofrequency Ablation

Athidi Guthikonda, Cary C. Cotton, Ryan D. Madanick, Melissa B. Spacek, Susan E. Moist, Kathleen Ferrell, Evan S. Dellon, Nicholas J. Shaheen

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Abstract

Objectives:Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE). However, recurrence of BE after initially successful RFA is common, and outcomes following recurrence not well described. We report the outcomes associated with recurrence following initially successful RFA.Methods:We performed a retrospective cohort study of 306 patients treated with RFA for dysplastic BE. Complete eradication of intestinal metaplasia (CE-IM) was defined as complete histological and endoscopic remission of IM. Recurrence was defined as any presence of IM or dysplasia in the tubular esophagus or dysplasia in the gastric cardia subsequent to CE-IM. We examined rates and risk factors for recurrence, dysplastic recurrence, and invasive adenocarcinoma after CE-IM. We also describe the clinical course of patients following recurrence.Results:Of the 306 eligible patients undergoing RFA, 218 achieved CE-IM and also had subsequent surveillance endoscopy. Of these, 52 (24%) experienced recurrence of IM or Barrett's-associated neoplasia over 540.6 person-years (incidence rate 9.6%/year). Thirty (58%) of these achieved second CE-IM; 4 (1.8% of total, 7.7% of recurrences) ultimately progressed to invasive adenocarcinoma (incidence rate 0.65%/year). Longer Prague M was a strong risk factor for invasive adenocarcinoma (rate ratio of 1.34/cm). Most dysplastic recurrences were in the cardia, and the majority were not visible but detected on random biopsies.Conclusions:Most patients with recurrent BE after initially successful RFA achieve second CE-IM; however, 1.8% progressed to invasive adenocarcinoma. Longer Prague M was predictive of invasive adenocarcinoma. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM.

LanguageEnglish (US)
Pages87-94
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume112
Issue number1
DOIs
StatePublished - Jan 1 2017

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Barrett Esophagus
Metaplasia
Recurrence
Adenocarcinoma
Cardia
Therapeutics
Endoscopy
Biopsy
Incidence
Esophagus
Stomach
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Clinical Outcomes Following Recurrence of Intestinal Metaplasia after Successful Treatment of Barrett's Esophagus with Radiofrequency Ablation. / Guthikonda, Athidi; Cotton, Cary C.; Madanick, Ryan D.; Spacek, Melissa B.; Moist, Susan E.; Ferrell, Kathleen; Dellon, Evan S.; Shaheen, Nicholas J.

In: American Journal of Gastroenterology, Vol. 112, No. 1, 01.01.2017, p. 87-94.

Research output: Contribution to journalArticle

Guthikonda, Athidi ; Cotton, Cary C. ; Madanick, Ryan D. ; Spacek, Melissa B. ; Moist, Susan E. ; Ferrell, Kathleen ; Dellon, Evan S. ; Shaheen, Nicholas J./ Clinical Outcomes Following Recurrence of Intestinal Metaplasia after Successful Treatment of Barrett's Esophagus with Radiofrequency Ablation. In: American Journal of Gastroenterology. 2017 ; Vol. 112, No. 1. pp. 87-94
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abstract = "Objectives:Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE). However, recurrence of BE after initially successful RFA is common, and outcomes following recurrence not well described. We report the outcomes associated with recurrence following initially successful RFA.Methods:We performed a retrospective cohort study of 306 patients treated with RFA for dysplastic BE. Complete eradication of intestinal metaplasia (CE-IM) was defined as complete histological and endoscopic remission of IM. Recurrence was defined as any presence of IM or dysplasia in the tubular esophagus or dysplasia in the gastric cardia subsequent to CE-IM. We examined rates and risk factors for recurrence, dysplastic recurrence, and invasive adenocarcinoma after CE-IM. We also describe the clinical course of patients following recurrence.Results:Of the 306 eligible patients undergoing RFA, 218 achieved CE-IM and also had subsequent surveillance endoscopy. Of these, 52 (24{\%}) experienced recurrence of IM or Barrett's-associated neoplasia over 540.6 person-years (incidence rate 9.6{\%}/year). Thirty (58{\%}) of these achieved second CE-IM; 4 (1.8{\%} of total, 7.7{\%} of recurrences) ultimately progressed to invasive adenocarcinoma (incidence rate 0.65{\%}/year). Longer Prague M was a strong risk factor for invasive adenocarcinoma (rate ratio of 1.34/cm). Most dysplastic recurrences were in the cardia, and the majority were not visible but detected on random biopsies.Conclusions:Most patients with recurrent BE after initially successful RFA achieve second CE-IM; however, 1.8{\%} progressed to invasive adenocarcinoma. Longer Prague M was predictive of invasive adenocarcinoma. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM.",
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AU - Moist,Susan E.

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N2 - Objectives:Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE). However, recurrence of BE after initially successful RFA is common, and outcomes following recurrence not well described. We report the outcomes associated with recurrence following initially successful RFA.Methods:We performed a retrospective cohort study of 306 patients treated with RFA for dysplastic BE. Complete eradication of intestinal metaplasia (CE-IM) was defined as complete histological and endoscopic remission of IM. Recurrence was defined as any presence of IM or dysplasia in the tubular esophagus or dysplasia in the gastric cardia subsequent to CE-IM. We examined rates and risk factors for recurrence, dysplastic recurrence, and invasive adenocarcinoma after CE-IM. We also describe the clinical course of patients following recurrence.Results:Of the 306 eligible patients undergoing RFA, 218 achieved CE-IM and also had subsequent surveillance endoscopy. Of these, 52 (24%) experienced recurrence of IM or Barrett's-associated neoplasia over 540.6 person-years (incidence rate 9.6%/year). Thirty (58%) of these achieved second CE-IM; 4 (1.8% of total, 7.7% of recurrences) ultimately progressed to invasive adenocarcinoma (incidence rate 0.65%/year). Longer Prague M was a strong risk factor for invasive adenocarcinoma (rate ratio of 1.34/cm). Most dysplastic recurrences were in the cardia, and the majority were not visible but detected on random biopsies.Conclusions:Most patients with recurrent BE after initially successful RFA achieve second CE-IM; however, 1.8% progressed to invasive adenocarcinoma. Longer Prague M was predictive of invasive adenocarcinoma. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM.

AB - Objectives:Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE). However, recurrence of BE after initially successful RFA is common, and outcomes following recurrence not well described. We report the outcomes associated with recurrence following initially successful RFA.Methods:We performed a retrospective cohort study of 306 patients treated with RFA for dysplastic BE. Complete eradication of intestinal metaplasia (CE-IM) was defined as complete histological and endoscopic remission of IM. Recurrence was defined as any presence of IM or dysplasia in the tubular esophagus or dysplasia in the gastric cardia subsequent to CE-IM. We examined rates and risk factors for recurrence, dysplastic recurrence, and invasive adenocarcinoma after CE-IM. We also describe the clinical course of patients following recurrence.Results:Of the 306 eligible patients undergoing RFA, 218 achieved CE-IM and also had subsequent surveillance endoscopy. Of these, 52 (24%) experienced recurrence of IM or Barrett's-associated neoplasia over 540.6 person-years (incidence rate 9.6%/year). Thirty (58%) of these achieved second CE-IM; 4 (1.8% of total, 7.7% of recurrences) ultimately progressed to invasive adenocarcinoma (incidence rate 0.65%/year). Longer Prague M was a strong risk factor for invasive adenocarcinoma (rate ratio of 1.34/cm). Most dysplastic recurrences were in the cardia, and the majority were not visible but detected on random biopsies.Conclusions:Most patients with recurrent BE after initially successful RFA achieve second CE-IM; however, 1.8% progressed to invasive adenocarcinoma. Longer Prague M was predictive of invasive adenocarcinoma. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM.

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