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Observational Study
. 2015 Dec;149(7):1752-1761.e1.
doi: 10.1053/j.gastro.2015.08.048. Epub 2015 Aug 29.

Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett's Esophagus

W Asher Wolf  1 , Sarina Pasricha  1 , Cary Cotton  1 , Nan Li  1 , George Triadafilopoulos  2 , V Raman Muthusamy  3 , Gary W Chmielewski  4 , F Scott Corbett  5 , Daniel S Camara  6 , Charles J Lightdale  7 , Herbert Wolfsen  8 , Kenneth J Chang  9 , Bergein F Overholt  10 , Ron E Pruitt  11 , Atilla Ertan  12 , Srinadh Komanduri  13 , Anthony Infantolino  14 , Richard I Rothstein  15 , Nicholas J Shaheen  16
Affiliations
Observational Study

Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett's Esophagus

W Asher Wolf et al. Gastroenterology. 2015 Dec.

Abstract

Background & aims: Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality.

Methods: We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality.

Results: Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA.

Conclusions: Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

Keywords: Esophageal Adenocarcinoma; Incidence; Mortality; NDBE.

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Figures

Figure 1
Figure 1. Kaplan-Meier Curves of EAC Incidence by Baseline Pathology
Figure 2
Figure 2. Probability of Developing EAC Based on Baseline Pathology and BE Segment Length. Derived via Multivariate Logistic Regression
Figure 3
Figure 3. Kaplan-Meier Survival Curves by Baseline Histology
See this image and copyright information in PMC

References

    1. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–1831. - PubMed
    1. Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P. Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67:394–398. - PubMed
    1. Zagari RM, Fuccio L, Wallander MA, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study. 2008;57:1354–1359. - PubMed
    1. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142–146. - PubMed
    1. Lepage C, Rachet B, Jooste V, Faivre J, Coleman MP. Continuing rapid increase in esophageal adenocarcinoma in England and Wales. Am J Gastroenterol. 2008;103:2694–2699. - PubMed

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