The long-term results of radiofrequency ablation (RFA) in patients with Barrett s esophagus related neoplasia

Abstract

Introduction: Radiofrequency ablation (RFA) with or without endoscopic resection (ER) is an established endoscopic treatment of early Barrett's esophagus (BE) related neoplasia (BORN). After successful treatment, follow-up is still required as recurrences may occur. The aim of this prospective single-center case series was to assess the long-term efficacy of endoscopic treatment (RFA with or without ER) for BORN. Main outcomes were complete remission of neoplasia (CR-N) and intestinal metaplasia (CR-IM) and recurrence of IM (RIM) and neoplasia (R-N). Aims & Methods: A total of 99 consecutive patients with BORN have been treated since 2009. Of those, 87 patients (75 men, mean age 64, range 22-91) completed the treatment and were included into this analysis. The patients had been followed up during 296 patient-years (mean 3.4 years, range 0.5-6). Thirtythree patients were diagnosed with adenocarcinoma (38%), 24 patients with highgrade dysplasia (28%) and 30 patients with low-grade dysplasia (34%). Prior to RFA, ER for visible lesions was performed in 57 patients (66%). Mean length of the Barrett's esophagus (BE) was 4.6 cm (range 1-13 cm). After treatment, the patients have undergone regular endoscopic surveillance with multiple biopsies. Results: Complete remission of IM (CR-IM) and complete remission of neoplasia (CR-N) were achieved in 54 patients (54/83 pts, 65.1%; 95% CI 54.3-74.5) and 82 patients (98.8%; 95% CI 92.8-99.9), respectively. All patients who did not achieve CR-IM had macroscopically normal neo-Z-line without visible abnormalities except one patient where macroscopic eradication of BE was not achieved due to giant hiatal hernia and who was referred for anti-reflux surgery. During the follow-up, 18 patients (33.3%, 18/54 pts) experienced a recurrence of IM and 3 patients (3.7%, 3/82 pts) had a recurrence of neoplasia (LGD 2x, HGD 1x). We did not encounter any patient with a subsquamous neoplasia. All recurrences occurred at the level of neo-Z-line and 6 patients with recurrent IM had also macroscopic recurrence of BE. A total of 13 patients underwent endoscopic retreatment: 7x probe-based re-RFA, 5x escape argon plasma coagulation (APC) and 1x ER. After retreatment, we achieved 100% CR-N and 54% (7/13 pts) CR-IM. Treatment-related adverse events occurred in 22 patients (25%): 12x chest pain and 10x stricture. Two patients with a stricture had to undergo surgical resection - first patient due to perforation during balloon dilatation of a post- RFA stricture, the second because of refractory post-RFA stricture after 20 sessions of dilatation. Conclusion: RFA combined with ER for patients with BORN achieves a high success rate of CR-N with durable results. Recurrence of IM occurs in approximately one-third of patients and supports continuous endoscopic surveillance even after complete eradication. Nonetheless, the majority of recurrent IM occurs within a normally appearing neo-Z-line with questionable clinical relevance. (Table Presented).