Endoscopy 2019; 51(04): 317-325
DOI: 10.1055/a-0739-7679
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Joke H. Vliebergh
1  Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
,
Pierre H. Deprez
2  Department of Gastroenterology and Hepatology, University Hospitals St-Luc, Brussels, Belgium
,
Danny de Looze
3  Department of Gastroenterology, University Hospitals Ghent, Belgium
,
Marc Ferrante
1  Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
,
Hans Orlent
4  Department of Gastroenterology, AZ St-Jan, Bruges, Belgium
,
Elisabeth Macken
5  Department of Gastroenterology, University Hospitals Antwerp, Belgium
,
Paul Christiaens
6  Department of Gastroenterology, Imelda Hospital Bonheiden, Belgium
,
Fazia Mana
7  Department of Gastroenterology, University Hospitals Brussels, Jette, Belgium
,
Gert De Hertogh
8  Department of Pathology, University Hospitals Leuven, Belgium
,
Hilde Willekens
1  Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
,
Raf Bisschops
1  Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
› Author Affiliations
Further Information

Publication History

submitted 08 January 2018

accepted after revision 16 July 2018

Publication Date:
25 October 2018 (eFirst)

Abstract

Background Radiofrequency ablation (RFA), combined with endoscopic resection, can be used as a primary treatment for low grade dysplasia, high grade dysplasia, and early esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE). The aim of the Belgian RFA registry is to capture the real-life outcome of endoscopic therapy for BE with RFA and to assess efficacy and safety outside study protocols, in the absence of reimbursement.

Patients and methods Between February 2008 and January 2017, data from 7 different expert centers were prospectively collected in the registry. Efficacy outcomes included complete remission of intestinal metaplasia (CR-IM), complete remission of dysplasia (CR-D), and durability of remission. Safety outcomes included immediate and late adverse events.

Results 684 RFA procedures in 342 different patients were registered. Of these, 295 patients were included in the efficacy analysis, with CR-IM achieved in 88 % and CR-D in 93 %, in per-protocol analysis; corresponding rates in intention-to-treat analysis were 82 % and 87 %, respectively. Sustained remission was seen in 65 % with a median (interquartile range) follow-up of 25 (12 – 47) months. No risk factors for recurrent disease were identified. Immediate complications occurred in 4 % of all procedures and 6 % of all patients, whereas late complications occurred in 9 % of all procedures and in 20 % of all patients.

Conclusions Data from the Belgian registry confirm that RFA in combination with endoscopic resection is an efficient treatment for BE with dysplasia or early EAC. In the absence of reimbursement, more rescue treatments are used, not compromising outcome. Since there is recurrent disease after CR-IM in 35 %, surveillance endoscopy remains necessary.

Table e2, e4, e5