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Radiofrequency Ablation in Patients with Barrett's Esophagus- related Neoplasia - Long-Term Outcomes in the Czech National Database

J. Krajciova, M. Janicko, P. Falt, J. Gregar, S. Suchanek, O. Ngo, M. Kollar, O. Urban, V. Prochazka, M. Zavoral, J. Spicak, J. Martinek,

. 2019 ; 28 (-) : 149-155. [pub] 20190601

Language English Country Romania

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc20006253

Grant support
NV16-27648A MZ0 CEP Register

BACKGROUND AND AIMS: Radiofrequency ablation (RFA) with/without endoscopic resection (ER) is the standard endoscopic treatment modality for Barrett's esophagus (BE) related neoplasia (BORN). The main aim of this study was to assess the long-term outcomes of RFA in patients with BORN. METHODS: We retrospectively analyzed the prospectively collected data from the Czech national database. Main outcomes were: complete remission of neoplasia (CR-N), complete remission of intestinal metaplasia (CR-IM), recurrence of both neoplasia and IM, and safety. RESULTS: From a total of 170 patients with BORN treated with RFA, 136 patients were analyzed. They were followed up for a median of 27.5 months. Fifty-six patients (41%) had low-grade intraepithelial neoplasia (LGIN), 46 (34%) had high-grade intraepithelial neoplasia (HGIN) and 34 (25%) had early adenocarcinoma (EAC). RFA was combined with previous ER in 65 patients (48%). CR-IM and CR-N were achieved in 77.9% (95% CI 70.0-84.6%) and 98.5% (95% CI 94.8-99.8%). Among 30 patients without CR-IM, 22 (73%) did not have macroscopic signs of BE. Recurrent neoplasia was detected in 4.5% of patients (6/134) and 15% (16/106) experienced a recurrence of IM at the level of the neo-Z-line. Diagnosis of cancer was an independent risk factor for recurrent IM after RFA (OR 7.0, 95% CI 1.6-30.9, p<0.0005). CONCLUSION: RFA is highly effective in achieving remission in patients with BORN. A significant proportion of patients did not achieve CR-IM or had a recurrence of IM despite macroscopically absent BE. Recurrence of neoplasia was infrequent but not negligible, thus, patients after successful RFA still require endoscopic surveillance.

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$a Krajciova, Jana $u Depart. of Hepatogastro- enterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Charles University, Institute of Physiology, First Faculty of Medicine, Prague, Czech Republic.
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$a BACKGROUND AND AIMS: Radiofrequency ablation (RFA) with/without endoscopic resection (ER) is the standard endoscopic treatment modality for Barrett's esophagus (BE) related neoplasia (BORN). The main aim of this study was to assess the long-term outcomes of RFA in patients with BORN. METHODS: We retrospectively analyzed the prospectively collected data from the Czech national database. Main outcomes were: complete remission of neoplasia (CR-N), complete remission of intestinal metaplasia (CR-IM), recurrence of both neoplasia and IM, and safety. RESULTS: From a total of 170 patients with BORN treated with RFA, 136 patients were analyzed. They were followed up for a median of 27.5 months. Fifty-six patients (41%) had low-grade intraepithelial neoplasia (LGIN), 46 (34%) had high-grade intraepithelial neoplasia (HGIN) and 34 (25%) had early adenocarcinoma (EAC). RFA was combined with previous ER in 65 patients (48%). CR-IM and CR-N were achieved in 77.9% (95% CI 70.0-84.6%) and 98.5% (95% CI 94.8-99.8%). Among 30 patients without CR-IM, 22 (73%) did not have macroscopic signs of BE. Recurrent neoplasia was detected in 4.5% of patients (6/134) and 15% (16/106) experienced a recurrence of IM at the level of the neo-Z-line. Diagnosis of cancer was an independent risk factor for recurrent IM after RFA (OR 7.0, 95% CI 1.6-30.9, p<0.0005). CONCLUSION: RFA is highly effective in achieving remission in patients with BORN. A significant proportion of patients did not achieve CR-IM or had a recurrence of IM despite macroscopically absent BE. Recurrence of neoplasia was infrequent but not negligible, thus, patients after successful RFA still require endoscopic surveillance.
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$a Janicko, Martin $u 1 st Depart. of Internal Medicine, P.J. Safarik University in Kosice, Faculty of Medicine and L. Pasteur University Hospital, Kosice, Slovakia.
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$a Falt, Premysl $u 2 nd Depart. of Internal Medicine, University Hospital, Olomouc, Czech Republic; Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
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$a Gregar, Jan $u 2 nd Depart. of Internal Medicine, University Hospital, Olomouc, Czech Republic; Faculty of Medicine, Palacky University, Olomouc, Czech Republic.
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$a Suchanek, Stepan $u Depart. of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague, Czech Republic.
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$a Ngo, Ondrej $u Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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$a Kollar, Marek $u Charles University, Institute of Physiology, First Faculty of Medicine, Prague, Czech Republic; Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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$a Urban, Ondrej $u 2 nd Depart. of Internal Medicine, University Hospital, Olomouc, Czech Republic; Faculty of Medicine, Palacky University, Olomouc, Czech Republic.
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$a Prochazka, Vlastimil $u 2 nd Depart. of Internal Medicine, University Hospital, Olomouc, Czech Republic; Faculty of Medicine, Palacky University, Olomouc, Czech Republic.
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$a Zavoral, Miroslav $u Depart. of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague, Czech Republic.
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$a Spicak, Julius $u Depart. of Hepatogastro- enterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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$a Martinek, Jan $u Depart. of Hepatogastro- enterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Charles University, Institute of Physiology, First Faculty of Medicine, Prague, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic. jan.martinek@volny.cz.
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