Length of Barrett’s segment predicts failure of eradication in radiofrequency ablation for Barrett’s esophagus: a retrospective cohort study

Abstract

BackgroundWe aim to investigate factors that may contribute to failure of eradication of dysplastic Barrett’s Esophagus among patients undergoing radiofrequency ablation treatment.MethodsA retrospective review of patients undergoing radiofrequency ablation for treatment of Barrett’s Esophagus was performed. Data analyzed included patient demographics, medical history, length of Barrett’s Esophagus, number of radiofrequency ablation sessions, and histopathology. Subsets of patients achieving complete eradication were compared with those not achieving complete eradication.ResultsA total of 107 patients underwent radiofrequency ablation for Barrett’s Esophagus, the majority white, overweight, and male. Before treatment, 63 patients had low-grade dysplasia, and 44 patients had high-grade dysplasia or carcinoma. Complete eradication was achieved in a majority of patients (57% for metaplasia, and 76.6% for dysplasia). Failure of eradication occurred in 15.7% of patients. The median number of radiofrequency ablation treatments in patients achieving complete eradication was 3 sessions, compared to 4 sessions for failure of eradication (p = 0.06). Barrett’s esophagus length of more than 5 cm was predictive of failure of eradication (p < 0.001).ConclusionsRadiofrequency ablation for dysplastic Barrett’s Esophagus is a proven and effective treatment modality, associated with a high rate of complete eradication. Our rates of eradication from a center starting an ablation program are comparable to previously published studies. Length of Barrett’s segment > 5 cm was found to be predictive of failure of eradication in patients undergoing radiofrequency ablation.

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

“…The length of Barrett's segment (greater than 5 cm) and number of RFA sessions (more than three) were significant predictors. 89 GERD, smoking, and male sex were also associated with incomplete CE-IM and CE-D; however, this was not significant. The association between more treatment sessions and failure of eradication may be explained by a more aggressive or invasive phenotype of disease.…”

“…Luckett et al identified a number of factors associated with the failure of RFA (Table 1). 89 With RFA, 43% of patients failed to achieve CE-IM and 23.4% of patients failed to achieve CE-D, and 15.7% of patients were lost to follow-up and did not have posttreatment biopsies. The length of Barrett's segment (greater than 5 cm) and number of RFA sessions (more than three) were significant predictors.…”

Endoscopic management of Barrett’s dysplasia and early neoplasia: efficacy, safety and long-term outcomes in a UK tertiary centre

“…Predictors of RFA failure are known to be length of BE segment, evidence of reflux, hiatus hernia length, race, duration of dysplasia and age. [35][36][37] Patients whose Barrett's esophagus is complicated with multifocal dysplasia, ulcerations and nodules are also likely to require more treatment sessions and therefore, may have a higher failure rate. However, numbers were too small in this cohort to investigate these factors further.…”

Critical Decision Making: Technical Aspects of Esophageal Ablation

“…The response to ablation, the likelihood of achieving complete remission and the risk of recurrence have been shown to be less favorable in patients with ongoing esophagitis, long segment Barrett's, multifocal dysplasia, large hiatal hernia, and narrowed esophagus. [1][2][3] These considerations are kept in mind when approaching patients and discussing the risks benefits and alternatives to treatments.…”