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Intestinal metaplasia recurrence uncommon after radiofrequency ablation for Barrett’s esophagus
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Patients with Barrett’s esophagus who undergo successful treatment with radiofrequency ablation are unlikely to experience disease recurrence or progression, according to recent results.
In a retrospective cohort study, researchers evaluated patients with dysplastic Barrett’s esophagus (BE) or intramucosal carcinoma (IMC) who experienced complete eradication of dysplasia (CE-D; n=119) or intestinal metaplasia (CE-IM; n=112) following radiofrequency ablation (RFA). Participants underwent endoscopic surveillance for a median of 397 days.
Dysplasia did not recur in 85% of CE-D patients after a median follow-up of 393 days. No cases of initial low-grade dysplasia resulted in recurrence, while high-grade dysplasia developed at a rate of 4.2% per year, with a median time to recurrence of 173 days.
Eight CE-IM patients experienced disease recurrence after a median of 235 days, including two cases of IMC pre-ablation, one of low- and five of high-grade dysplasia. One participant progressed to IMC, and two developed esophageal adenocarcinoma (EAC), with high-grade dysplasia present before ablation in each case. The remaining five patients developed nondysplastic BE (three cases) and low- and high-grade dysplasia (one case each).
Overall, recurrence rate over 155 patient-years was 5.2% per year, while recurrence with high-grade dysplasia or worse histology occurred at a rate of 2.6% per year, recurrence with EAC at 1.3% per year and death from EAC at a rate of 0.6% per year.
Using bivariate analysis, differences between patients who experienced recurrence and those who did not were not significant, although those with recurrence tended to be younger, have higher BMI and a longer length of BE. They also were more likely to have erosive esophagitis, hiatal hernia, esophageal stricture or histology of IMC before ablation.
“In general, these results should serve to reassure patients and their physicians that, in most cases, RFA induces a durable complete eradication of dysplasia and intestinal metaplasia,” the researchers concluded. “At the same time, the few cases of progression point to the need for continued surveillance following treatment. Further follow-up … is needed to identify predictors of IM recurrence so that continued surveillance can be appropriately targeted to the highest risk patients.”
Disclosure: See the study for a full list of relevant disclosures.
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