Safety, efficacy, and changing trends in endoscopic ablation for dysplastic Barrett esophagus in Poland: a long‑term multicenter retrospective analysis

Abstract

INTRODUCTION Endoscopic ablation is the mainstay of treatment for dysplastic Barrett esophagus (BE), of which radiofrequency ablation (RFA) and argon plasma coagulation (APC) are the most widely available options. OBjECTIvES We aimed to analyze the safety and outcomes of endoscopic ablation for BE at the Polish centers offering this procedure. PATIENTS AND METHODS We retrospectively analyzed data from 3 high‑volume endoscopy centers be‑ tween 2002 and 2024. We included adult patients with confirmed BE who received at least 1 ablation session with either conventional / hybrid APC (APC/h‑APC) or RFA, followed by at least 1 endoscopic follow‑up. The outcomes included the rate of complete remission of intestinal metaplasia (CR‑IM) and dysplasia (CR‑D), and adverse event (AE) rate. Risk factors for treatment failure were analyzed using a multivariable logistic regression model. RESULTS We analyzed data from 191 patients, of which 160 were included (mean [SD] age, 59.4 [10.8] years; 79.4% men). The overall CR‑IM and CR‑D rates were 80% and 93.8%, respectively. We reported 49 minor AEs (30.6%), and 9 major AEs (5.6%), including 7 esophageal strictures (4.4%). In the early 2000s, APC was the only available ablation modality. However, since 2008, it has been gradually replaced by RFA. Notably, RFA was used for more severe BE cases and carried a higher risk of failed treatment than APC/h‑APC (odds ratio [OR], 7.48; P = 0.001). Other risk factors for treatment failure included the BE length (OR, 1.3; P = 0.002) and diabetes (OR, 7.48; P <0.001). CONCLUSIONS Endoscopic ablation for BE is safely and effectively provided in Poland at a few expert centers. Patients with diabetes and long‑segment BE are at an increased risk for treatment failure.