Durability of radiofrequency ablation for long-segment and ultralong-segment Barrett’s esophagus over 10 years

• Published in: Surgical endoscopy Vol. 38; no. 3; pp. 1239 - 1248
• Main Authors: Nguyen, Chu Luan, Tovmassian, David, Zhou, Michael, Seyfi, Doruk, Gooley, Suzanna, Falk, Gregory L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Ablation; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Biopsy; Cancer; Catheter Ablation; Endoscopy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagoscopy; Esophagus; Gastroenterology; Gastroesophageal reflux; Gynecology; Hepatology; Hernias; Humans; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - surgery; Pathologic Complete Response; Proctology; Radiofrequency Ablation; Remission (Medicine); Retrospective Studies; Surgery; Surveillance; Treatment Outcome; Radiofrequency ablation; Barrett’s esophagus; Endoscopic resection; Long-segment; Ultralong-segment
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10608-7

Background
Long-term durability data for radiofrequency ablation (RFA) to prevent esophageal adenocarcinoma in long-segment (LSBE) and ultralong-segment Barrett’s esophagus (ULSBE) is lacking. This study aimed to determine 10-year cancer progression, eradication, and complication rates in LSBE and ULSBE patients treated with RFA.
Methods
Single-surgeon prospective database of patients with LSBE (≥ 3 to < 8 cm) and ULSBE (≥ 8 cm) who underwent RFA (2001–2021) were retrospectively analyzed. Ten-year cancer progression calculated with Kaplan–Meier analysis. Eradication rates, including complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), and rates of recurrence and complications, compared between LSBE and ULSBE groups.
Results
Ten years after starting treatment, the cancer rate was 14.3% in 56 patients. CR-D and CR-IM rates were 87.5% and 67.9%, respectively. Relapse rates from CR-D were 1.8% and 3.6% from CR-IM. Eradication rates for dysplasia in LSBE and ULSBE patients (90.6% versus 83.3%) and IM (71.9% versus 62.5%) were not significantly different. ULSBE patients required higher mean number of ablation sessions for IM eradication (4.7 versus 3.7,
p
 = 0.032), while complication rates including strictures (4.2% versus 6.2%), perforation (0 versus 0), and bleeding (4.2% versus 3.1%), were similar between ULSBE and LSBE patients, respectively. On multivariate analysis, shorter Barrett’s segment and baseline low-grade dysplasia were associated with increased likelihood for eradication of IM and dysplasia. A total number of ablation sessions or endoscopic resections ≥ 3 was associated with reduced likelihood for eradication.
Conclusion
RFA was durable in maintaining dysplasia and IM eradication in both LSBE and ULSBE over 10 years, and with low complication rates. IM eradication was more difficult to achieve in ULSBE. Late development of cancer occurred in 14.3%.