In the Journals

Radiofrequency ablation reduces neoplastic progression in Barrett's esophagus

Patients with Barrett’s esophagus and confirmed low-grade dysplasia who underwent radiofrequency ablation had lower rates of neoplastic progression, according to new research data.

To determine the rate of progression of low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma (EAC) in patients with BE who underwent radiofrequency ablation compared with endoscopic surveillance alone, Meenakshi Bewtra, MD, PhD, MPH, from the Perelman School of Medicine, University of Pennsylvania, and colleagues performed a retrospective study of patients from three U.S. referral centers within the Barrett’s Esophagus Translational Research Network (BETRNet).

Meenakshi Bewtra

They evaluated 45 patients who underwent radiofrequency ablation (median follow-up, 29.6 months; interquartile range [IQR], 8.8-54.1 months) and 125 who underwent surveillance endoscopy (median follow-up, 28.3 months; IQR, 10.7-78.5 months) for confirmed low-grade dysplasia from October 1992 to 2013. They also sought to identify independent risk factors associated with progression.

The annual rate of progression to high-grade dysplasia or EAC was 6.6% in the surveillance group compared with 0.77% in the radiofrequency ablation group. Patients who underwent radiofrequency ablation had significantly lower risk of progression to high-grade dysplasia or EAC compared with those who underwent surveillance alone (adjusted HR = 0.06; 95% CI, 0.008-0.48). The estimated 3-year cumulative risk of progression to high-grade dysplasia or EAC was 2.9% (95% CI, 0.4-20.3) in the radiofrequency ablation group compared with 33% (95% CI, 22.9-47.6) in the surveillance group (number needed to treat, 3).

Independent predictors of progression in the surveillance group included nodularity (HR = 3.12; 95% CI, 1.18-8.25) and multifocal dysplasia (HR = 3.09; 95% CI, 1.49-6.41).

“In conclusion, our results in conjunction with … recent clinical trial data suggest that endoscopic ablation has potential benefit over endoscopic surveillance in the management of referred patients with [low-grade dysplasia] confirmed by an expert pathologist,” the researchers wrote. “The high neoplastic progression rates in patients undergoing surveillance alone, the low number need to treat to avoid progression to [high-grade dysplasia] or cancer, and the excellent safety profile of [radiofrequency ablation] reported to date now provide additional evidence supporting ablation for Barrett’s patients with confirmed [low-grade dysplasia]. Confirmation of [low-grade dysplasia] by an expert GI pathologist is critical before a decision to ablate.” – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures. 

Patients with Barrett’s esophagus and confirmed low-grade dysplasia who underwent radiofrequency ablation had lower rates of neoplastic progression, according to new research data.

To determine the rate of progression of low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma (EAC) in patients with BE who underwent radiofrequency ablation compared with endoscopic surveillance alone, Meenakshi Bewtra, MD, PhD, MPH, from the Perelman School of Medicine, University of Pennsylvania, and colleagues performed a retrospective study of patients from three U.S. referral centers within the Barrett’s Esophagus Translational Research Network (BETRNet).

Meenakshi Bewtra

They evaluated 45 patients who underwent radiofrequency ablation (median follow-up, 29.6 months; interquartile range [IQR], 8.8-54.1 months) and 125 who underwent surveillance endoscopy (median follow-up, 28.3 months; IQR, 10.7-78.5 months) for confirmed low-grade dysplasia from October 1992 to 2013. They also sought to identify independent risk factors associated with progression.

The annual rate of progression to high-grade dysplasia or EAC was 6.6% in the surveillance group compared with 0.77% in the radiofrequency ablation group. Patients who underwent radiofrequency ablation had significantly lower risk of progression to high-grade dysplasia or EAC compared with those who underwent surveillance alone (adjusted HR = 0.06; 95% CI, 0.008-0.48). The estimated 3-year cumulative risk of progression to high-grade dysplasia or EAC was 2.9% (95% CI, 0.4-20.3) in the radiofrequency ablation group compared with 33% (95% CI, 22.9-47.6) in the surveillance group (number needed to treat, 3).

Independent predictors of progression in the surveillance group included nodularity (HR = 3.12; 95% CI, 1.18-8.25) and multifocal dysplasia (HR = 3.09; 95% CI, 1.49-6.41).

“In conclusion, our results in conjunction with … recent clinical trial data suggest that endoscopic ablation has potential benefit over endoscopic surveillance in the management of referred patients with [low-grade dysplasia] confirmed by an expert pathologist,” the researchers wrote. “The high neoplastic progression rates in patients undergoing surveillance alone, the low number need to treat to avoid progression to [high-grade dysplasia] or cancer, and the excellent safety profile of [radiofrequency ablation] reported to date now provide additional evidence supporting ablation for Barrett’s patients with confirmed [low-grade dysplasia]. Confirmation of [low-grade dysplasia] by an expert GI pathologist is critical before a decision to ablate.” – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.