Novel risk model predicts treatment complexity in BE after radiofrequency ablation
A novel risk model predicted treatment complexity among patients with Barrett’s esophagus following initial radiofrequency ablation treatment, according to research published in Clinical Gastroenterology and Hepatology.
“Endoscopic eradication therapy (EET) is well established for Barrett’s with early neoplasia. EET typically consists of endoscopic resection of visible abnormalities, followed by radiofrequency ablation (RFA),” Sanne van Munster, MD, of the department of gastroenterology and hepatology at Amsterdam University Medical Centers, and colleagues wrote. “This dual modality treatment has been proven safe and results in a complete eradication of BE (CE-BE) in 74% to 98% of patients. ... However, a subgroup of patients will experience a more complex treatment course.”
To promote early identification and treatment course prediction, Munster and colleagues developed and validated a prognostic model using data from 1,356 patients in the Barrett Expert Center registry in the Netherlands who underwent EET for BE associated neoplasia. The primary endpoint was identification of a complex treatment course defined as neoplastic progression, treatment failure and/or the need for subsequent resection during RFA treatment.
According to study results, 6% of patients had a complex treatment course and a higher risk for more than four RFA treatments (RR = 2.7; 95% CI, 1.3-5.6), esophageal stenosis (RR = 2.3; 95% CI, 1.6-3.1) and bleeding (RR = 2.6; 95% CI, 1.2-5.6), compared with patients with a straightforward treatment course. Univariate analysis found increased length of BE, visible lesion at baseline, high grade dysplasia or esophageal adenocarcinoma at baseline and squamous conversion less than 50% following initial RFA independently predicted complex treatment course. Squamous regeneration after RFA had the highest predictive value (adjusted OR = 21.2; 95% CI, 11.5-40.5).
Investigators also performed external validation in 282 patients from a prospective RFA registry at the University Hospital Leuven, which generated an area under of the curve of 0.84 (95% CI, 0.78-0.9).
“Our model identified two patient profiles with a high risk for complex treatment: patients with BE length over 9cm containing high grade dysplasia/EAC and patients with poor squamous regeneration after RFA,” Munster and colleagues concluded. “This model has the potential to impact treatment of BE patients in terms of patient counseling and rational application of ablation therapy.”
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