Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry

W. D. Lyday; F. S. Corbett; D. A. Kuperman; I. Kalvaria; P. G. Mavrelis; A. B. Shughoury; R. E. Pruitt

doi:10.1055/s-0029-1243883

Endoscopy, Inhaltsverzeichnis

Endoscopy 2010; 42(4): 272-278
DOI: 10.1055/s-0029-1243883

Original article

Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry

W. D. Lyday¹ , F. S. Corbett² , D. A. Kuperman² , I. Kalvaria² , P. G. Mavrelis³ , A. B. Shughoury³ , R. E. Pruitt⁴

¹The Center for GI Health, Cancer Prevention, Management and Nutritional Therapy, A Division of Atlanta Gastroenterology Associates, LLC, Atlanta, Atlanta, Georgia, USA
²Sarasota Memorial Hospital, Sarasota, Florida, USA
³St Mary’s Medical Center, Hobart, Indiana, USA
⁴Maria Nathanson Center of Excellence at St Thomas Hospital, Nashville, Tennessee, USA

Abstract

Background and study aims: The use of radiofrequency ablation (RFA) for complete eradication of Barrett’s esophagus has shown promise in trials conducted at predominantly tertiary academic centers; however less is known regarding outcomes in the community. We evaluated the safety and efficacy of RFA for Barrett’s esophagus delivered in a community practice setting.

Patients and methods: This was a multicenter registry conducted in community-based gastroenterology practices. Patients had confirmed intestinal metaplasia with or without dysplasia on biopsy of a Barrett’s esophagus. Intervention was step-wise RFA with follow-up esophageal biopsies. Endpoints were histology-based; complete response was defined as all biopsies at most recent endoscopy negative for intestinal metaplasia (CR-IM) or dysplasia (CR-D). Three cohorts were reported: 1) safety cohort, all patients; 2) efficacy cohort A, patients with at least one biopsy session after initial treatment; 3) efficacy cohort B, patients with at least one biopsy session ≥ 1 year after initial treatment.

Results: The safety cohort included 429 patients (71 % men, median age 59 years, median Barrett’s segment 3.0 cm). There were no serious adverse events (bleeding, perforation, death), and a stricture occurred after 1.1 % of cases (2.1 % of patients). In efficacy cohort A (n = 338), CR-IM and CR-D were achieved in 72 % and 89 % of patients, respectively (median follow-up 9 months). In efficacy cohort B (n = 137), CR-IM and CR-D were achieved in 77 % and 100 % of patients, respectively (median follow-up 20 months).

Conclusions: In this multicenter registry conducted at four community-based practices, the observed safety and efficacy outcomes associated with RFA for Barrett’s esophagus are comparable to those previously reported in multicenter trials from predominantly tertiary academic centers.

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