Radiofrequency ablation of Barrett's esophagus with low-grade dysplasia is recommended in recent American College of Gastroenterology guidelines, with endoscopic surveillance considered a reasonable alternative. Few studies have directly compared outcomes of radiofrequency ablation to surveillance and those that have are limited by short duration of follow-up. This study aims to compare the long-term effectiveness of radiofrequency ablation versus endoscopic surveillance in a large, longitudinal cohort of patients with Barrett's esophagus, and low-grade dysplasia.We conducted a retrospective analysis of patients with confirmed low-grade dysplasia at a single academic medical center from 1991 to 2014. Patients progressing to high-grade dysplasia or esophageal adenocarcinoma within one year of index LGD endoscopy were defined as missed dysplasia and excluded. Risk factors for progression were assessed via Cox proportional hazards model. Comparison of progression risk was conducted using a Kaplan-Meier analysis. Subset analyses were conducted to examine the effect of reintroducing early progressors and excluding patients diagnosed prior to the advent of ablative therapy. Of 173 total patients, 79 (45.7%) underwent radiofrequency ablation while 94 (54.3%) were untreated, with median follow up of 90 months. Seven (8.9%) patients progressed to high-grade dysplasia or adenocarcinoma despite ablation, compared with 14 (14.9%) undergoing surveillance (P = 0.44). This effect was preserved when patients diagnosed prior to the introduction of radiofrequency ablation were excluded (8.9% vs 13%, P = 0.68). Reintroduction of patients progressing within the first year of follow-up resulted in a trend toward significance for ablation versus surveillance (11.1% vs 23.8%, P = 0.053).In conclusion, progression to high-grade dysplasia or adenocarcinoma was not significantly reduced in the radiofrequency ablation cohort when compared to surveillance. Despite recent studies suggesting the superiority of radiofrequency ablation in reducing progression, diligent endoscopic surveillance may provide similar long-term outcomes.

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Though DAAs have eliminated many historically, long-standing medical barriers to HCV treatment, several racial, psychological and socioeconomic barriers, and disparities remain. Consequently, patients who are African American, uninsured, and actively use drugs and alcohol will suffer from increased HCV-related morbidity and mortality in the coming years if deliberate public health and clinical efforts are not made to facilitate access to DAAs.

Background and AimsThe aims of this study were to examine changes in the proportion of decompensated hepatitis C virus (HCV) cirrhosis patients with ascites, hepatic encephalopathy, and variceal bleeding at pretreatment compared to 3 and 12 months post‐sustained virological response (SVR) and to compare pretreatment and post‐SVR model of end‐stage liver disease and Child‐Pugh scores and alpha‐fetoprotein levels.MethodsElectronic medical records of 64 decompensated HCV cirrhosis patients who received direct‐acting antivirals were reviewed. The McNemar–Bowker test and the Wilcoxon‐Signed Rank test were used to compare patient outcomes.ResultsAscites was resolved in 29% of patients 3 months post‐SVR (65% vs 36%, P < 0.01) and in 35% of patients 12 months post‐SVR (65% vs 30%, P = 0.07). Hepatic encephalopathy was resolved in 54% of patients 3 months post‐SVR (70% vs 16%, P < 0.01) and in 48% of patients 12 months post‐SVR (70% vs 22% P = 0.03). Variceal bleeding was absent in 32% of patients 3 months post‐SVR (35% vs 3%, P < 0.01) and in 27% of patients 12 months post‐SVR (35% vs 8%, P < 0.01). Alpha‐fetoprotein levels were significantly reduced post‐SVR, but model of end‐stage liver disease and Child‐Pugh scores were not.ConclusionsDecompensated HCV cirrhosis patients who achieved SVR with direct‐acting antiviral treatment had significant reductions in manifestations of hepatic decompensation sustainable up to 1 year post‐SVR.