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Comparative Study
. 2015 Sep;149(3):567-76.e3; quiz e13-4.
doi: 10.1053/j.gastro.2015.04.013. Epub 2015 Apr 24.

Radiofrequency Ablation Is Associated With Decreased Neoplastic Progression in Patients With Barrett's Esophagus and Confirmed Low-Grade Dysplasia

Aaron J Small  1 , James L Araujo  2 , Cadman L Leggett  3 , Aaron H Mendelson  4 , Anant Agarwalla  4 , Julian A Abrams  2 , Charles J Lightdale  2 , Timothy C Wang  2 , Prasad G Iyer  3 , Kenneth K Wang  3 , Anil K Rustgi  4 , Gregory G Ginsberg  4 , Kimberly A Forde  5 , Phyllis A Gimotty  6 , James D Lewis  5 , Gary W Falk  5 , Meenakshi Bewtra  5
Affiliations
Comparative Study

Radiofrequency Ablation Is Associated With Decreased Neoplastic Progression in Patients With Barrett's Esophagus and Confirmed Low-Grade Dysplasia

Aaron J Small et al. Gastroenterology. 2015 Sep.

Abstract

Background & aims: Barrett's esophagus (BE) with low-grade dysplasia (LGD) can progress to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) has been shown to be an effective treatment for LGD in clinical trials, but its effectiveness in clinical practice is unclear. We compared the rate of progression of LGD after RFA with endoscopic surveillance alone in routine clinical practice.

Methods: We performed a retrospective study of patients who either underwent RFA (n = 45) or surveillance endoscopy (n = 125) for LGD, confirmed by at least 1 expert pathologist, from October 1992 through December 2013 at 3 medical centers in the United States. Cox regression analysis was used to assess the association between progression and RFA.

Results: Data were collected over median follow-up periods of 889 days (interquartile range, 264-1623 days) after RFA and 848 days (interquartile range, 322-2355 days) after surveillance endoscopy (P = .32). The annual rates of progression to HGD or EAC were 6.6% in the surveillance group and 0.77% in the RFA group. The risk of progression to HGD or EAC was significantly lower among patients who underwent RFA than those who underwent surveillance (adjusted hazard ratio = 0.06; 95% confidence interval: 0.008-0.48).

Conclusions: Among patients with BE and confirmed LGD, rates of progression to a combined end point of HGD and EAC were lower among those treated with RFA than among untreated patients. Although selection bias cannot be excluded, these findings provide additional evidence for the use of endoscopic ablation therapy for LGD.

Keywords: Clinical Setting; Eradication; Esophageal Cancer; Prevention.

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Conflict of interest statement

The authors have no personal or financial conflicts of interest in any content or products mentioned in this manuscript.

Figures

Figure 1
Figure 1
Flow Diagram of Patients Meeting Study Criteria *Follow-up period starting from date of first intervention of LGD until date of last endoscopy with biopsies in the medical chart
Figure 2
Figure 2
Progression to High-Grade Dysplasia or Adenocarcinoma from Time of First RFA or Surveillance Endoscopy.
See this image and copyright information in PMC

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