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Dysplasia, length, center experience predict Barrett’s recurrence
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CHICAGO — In patients with Barrett’s esophagus, baseline dysplasia, longer BE length and treatment at centers with fewer average procedures increased the risk of BE recurrence following radiofrequency ablation, according to results of a veteran cohort study presented at Digestive Disease Week.
“We found that BE recurrence rate of 10.8% per patient-year after RFA in a community practice setting in a multi-center VA study was similar to previously reported rates,” Mimi Chang Tan, MD, from the department of medicine, Baylor College of Medicine, Houston, said in a presentation. “We also found that high-volume RFA centers have better outcomes than less experienced centers.”
The researchers enrolled 303 patients from 40 facilities in the Veterans Health Administration in the retrospective study. The patients had been diagnosed with BE, had at least one RFA treatment between 2004 and 2009 and achieved complete eradication of intestinal metaplasia. Mean patient age was 64.6 years, 98.3% were men and 82.2% were white.
BE recurrence was observed in 98 patients, including 20 patients with dysplasia recurrence and three patients with esophageal adenocarcinoma recurrence. Per patient year, overall BE recurrence was 10.8%, dysplasia recurrence was 2.2% and EAC recurrence was 0.3%.
Per patient-year, BE recurrence after complete eradication of intestinal metaplasia was higher in the 59 patients with baseline dysplasia (14.2%) and the 14 patients with intramucosal cancer (21.1%) compared with the other 25 patients (7.3%). BE recurrence was also more common in older patients, particularly in patients older than 80 years, and in patients with BE length of 3 cm or longer compared with patients with BE length of less than 3 cm.
Patients who underwent RFA at VA facilities that were observed in the lowest quartile of ablations performed — approximately less than two procedures per year between 2005 and 2014 — had a rate of 61.6% per year of BE recurrence compared with facilities in the highest quartile — typically more than eight procedures per year in the same period — which had a rate of 10.6% per year.
“We have a predominantly male veteran population that was included, so this limits the external validity,” Tan said. “However, BE and EAC are diseases in older men, so our results could be extrapolated to this population.” – by Talitha Bennett
References:
Tan MC, et al. Abstract 242. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Disclosure : Tan reports no relevant financial disclosures.