Barrett's esophagus recurrence after radiofrequency ablation in U.S. veterans: A retrospective cohort study
Barrett’s esophagus (BE) is the only known pre-malignant condition of esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) therapy is effective for treating BE; however, some patients experience BE recurrence after RFA and complete eradication of intestinal metaplasia (CEIM). The purpose of this study was to determine the incidence and predictors of BE recurrence after RFA treatment in a national, multi-center, community practice cohort. This retrospective cohort study included veterans with a diagnosis of BE between 2004-2009 and ≥1 RFA treatment who were followed until BE recurrence, death or October 31, 2016. Recurrence of BE and clinical predictors of recurrence were determined on chart review. We calculated the incidence rates of BE recurrence after CEIM (number of cases divided by total number of follow-up years contributed by the study population at risk) and examined associations with time to BE recurrence using Kaplan-Meier analyses and Cox proportional hazards modeling. We identified 469 BE patients treated with RFA, of whom 303 achieved CEIM and underwent surveillance endoscopy post-CEIM. Most were men (98.3%) and White (82.2%), with a mean age of 64.6 years. Of these patients, 115 (38.0%) had non-dysplastic BE (NDBE), 161 (53.1%) dysplasia, and 27 (8.9%) intramucosal cancer (IMC) at baseline. BE recurrence was observed in 98 over 826.8 patient-years follow-up (incidence rate 11.9% per patient-year). EAC after CEIM developed in 3 patients (incidence rate 0.4% per patient-year). BE recurrence after CEIM was higher among those with baseline dysplasia (14.2%/year) or IMC (21.1%/year) than those with NDBE (7.3%/year). Patients undergoing RFA at VA facilities in the lowest quartile of ablations performed had higher rates of BE recurrence after CEIM (61.6%/year) than patients at facilities in the highest quartile (10.6%/year). On multivariate analysis, baseline dysplasia (HR=1.74; 95% CI 1.07-2.84) and facility RFA experience (highest vs. lowest quartile, HR 0.13, 95% CI 0.04-0.45) remained significant predictors of BE recurrence, while BE length and age were not associated with BE recurrence risk. This national, multi-center cohort study of community practice outcomes after RFA found baseline dysplastia and treatment at facilities in the lowest quartile of ablations performed were significant predictors of increased BE recurrence risk.
Tan, Mimi Chang, "Barrett's esophagus recurrence after radiofrequency ablation in U.S. veterans: A retrospective cohort study" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10249103.