Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study

F. G. I. van Vilsteren; L. Alvarez Herrero; R. E. Pouw; D. Schrijnders; C. M. T. Sondermeijer; R. Bisschops; J. M. Esteban; A. Meining; H. Neuhaus; A. Parra-Blanco; O. Pech; K. Ragunath; B. Rembacken; B. E. Schenk; M. Visser; F. J. W. ten Kate; S. L. Meijer; J. B. Reitsma; B. L. A. M. Weusten; E. J. Schoon; J. J. G. H. M. Bergman

doi:10.1055/s-0032-1326423

Endoscopy, Table of Contents

Endoscopy 2013; 45(07): 516-525
DOI: 10.1055/s-0032-1326423

Original article

Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study

F. G. I. van Vilsteren

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

,

L. Alvarez Herrero

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

²Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands

,

R. E. Pouw

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

,

D. Schrijnders

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

,

C. M. T. Sondermeijer

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

,

R. Bisschops

³Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium

,

J. M. Esteban

⁴Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain

,

A. Meining

⁵Department of Gastroenterology, Klinikum rechts der Isar, München, Germany

,

H. Neuhaus

⁶Department of Gastroenterology, Evangelisches Krankenhaus, Düsseldorf, Germany

,

A. Parra-Blanco

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

¹⁵Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile

,

O. Pech

⁸Department of Gastroenterology, Dr.-Horst-Schmidt-Kliniken, Wiesbaden, Germany

,

K. Ragunath

⁹Department of Gastroenterology, Queens Medical Centre, Nottingham, UK

,

B. Rembacken

¹⁰Department of Gastroenterology, St James Hospital, Leeds, UK

,

B. E. Schenk

¹¹Department of Gastroenterology, Isala Klinieken, Zwolle, The Netherlands

,

M. Visser

¹²Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

,

F. J. W. ten Kate

¹²Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

,

S. L. Meijer

¹²Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

,

J. B. Reitsma

¹³Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

,

B. L. A. M. Weusten

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

²Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands

,

E. J. Schoon

¹⁴Department of Gastroenterology, Catharina Hospital Eindhoven, The Netherlands

,

J. J. G. H. M. Bergman

¹Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Background and study aims: Radiofrequency ablation (RFA) is safe and effective for the eradication of neoplastic Barrett’s esophagus; however, occasionally there is minimal regression after initial circumferential balloon-based RFA (c-RFA). This study aimed to identify predictive factors for a poor response 3 months after c-RFA, and to relate the percentage regression at 3 months to the final treatment outcome.

Methods: We included consecutive patients from 14 centers who underwent c-RFA for high grade dysplasia at worst. Patient and treatment characteristics were registered prospectively. “Poor initial response” was defined as < 50 % regression of the Barrett’s esophagus 3 months after c-RFA, graded by two expert endoscopists using endoscopic images. Predictors of initial response were identified through logistic regression analysis.

Results: There were 278 patients included (median Barrett’s segment C4M6). In poor initial responders (n = 36; 13 %), complete response for neoplasia (CR-neoplasia) was ultimately achieved in 86 % (vs. 98 % in good responders; P < 0.01) and complete response for intestinal metaplasia (CR-IM) in 66 % (vs. 95 %; P < 0.01). Poor responders required 13 months treatment (vs. 7 months; P < 0.01) for a median of four RFA sessions (vs. three; P < 0.01). We identified four independent baseline predictors of poor response: active reflux esophagitis (odds ratio [OR] 37.4; 95 % confidence interval [CI] 3.2 – 433.2); endoscopic resection scar regeneration with Barrett’s epithelium (OR 4.7; 95 %CI 1.1 – 20.0); esophageal narrowing pre-RFA (OR 3.9; 95 %CI 1.0 – 15.1); and years of neoplasia pre-RFA (OR 1.2; 95 %CI 1.0 – 1.4).

Conclusions: Patients with a poor initial response to c-RFA have a lower ultimate success rate for CR-neoplasia/CR-IM, require more treatment sessions, and a longer treatment period. A poor initial response to c-RFA occurs more frequently in patients who regenerate their endoscopic resection scar with Barrett’s epithelium, and those with ongoing reflux esophagitis, neoplasia in Barrett’s esophagus for a longer time, or a narrow esophagus.

Full Text

References

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