Repeat RF ablation for recurrent Barrett's esophagus usually successful

Last Updated: 2016-11-03

By Reuters Staff

NEW YORK (Reuters Health) - Most patients with recurrence of Barrett's esophagus achieve complete eradication of intestinal metaplasia after repeat radiofrequency ablation (RFA), a new study suggests.

Recurrence of Barrett's esophagus (BE) following ablative therapies is common, but outcomes after recurrence are not well described, researchers write in the American Journal of Gastroenterology, online October 11.

Dr. Nicholas Shaheen of the University of North Carolina at Chapel Hill and his colleagues conducted a retrospective cohort study of 306 patients treated with RFA for dysplastic BE over a roughly nine-year period at the hospitals of one university.

Two hundred eighteen achieved complete eradication of intestinal metaplasia (CE-IM) followed by surveillance endoscopy. Of these, 52 (24%) had recurrence of IM or Barrett's-associated neoplasia over 540.6 person-years (incidence rate 9.6%/year); 30 (58%) of them achieved second CE-IM; and four (1.8% of total, 7.7% of recurrences) progressed to invasive adenocarcinoma (incidence rate 0.65%/year).

Longer Prague M was an important risk factor for invasive adenocarcinoma (rate ratio of 1.34/cm). Most dysplastic recurrences were in the cardia, but were not visible and were detected by random biopsies. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM, the authors say.

"Dysplastic recurrence in the cardia actually represented the majority of dysplastic recurrences detected during endoscopic surveillance," they note. "Whether these lesions represented de novo occurrences, or were prevalent lesions that existed prior to ablation but only discovered in postablation surveillance, is unclear."

The researchers say their findings "further emphasize the importance of thorough and ongoing endoscopic surveillance following CE-IM in patients treated with RFA therapy for BE. Routine measurement of Prague C (circumference) and M (maximal) length is indicated to better identify and manage patients with a higher risk for recurrence."

They add, "As a substantial proportion (63.8%) of recurrences can be successfully retreated and second CE-IM can be re-established, endoscopic surveillance offers the potential to detect and treat recurrence before progression to invasive cancer."

The study did not have commercial funding.

SOURCE: http://bit.ly/2ehVJmS

Am J Gastroenterol 2016.