Endoscopy 2021; 53(S 01): S31-S32
DOI: 10.1055/s-0041-1724334
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Thursday, 25 March 2021 18:00 – 18:45 Barrett’s and beyond Room 6

Poor Healing and Poor Squamous Regeneration after Radiofrequency Ablation Therapy for Early Barrett’s Neoplasia: Incidence, Risk Factors and Outcomes

SN van Munster
1   St. Antonius Hospital, Gastroenterology & Hepatology, Nieuwegein, Netherlands
2   Amsterdam University Medical Centers, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
CN Frederiks
1   St. Antonius Hospital, Gastroenterology & Hepatology, Nieuwegein, Netherlands
3   University Medical Center Utrecht, Gastroenterology & Hepatology, Utrecht, Netherlands
,
L Alvarez Herrero
1   St. Antonius Hospital, Gastroenterology & Hepatology, Nieuwegein, Netherlands
,
A Bogte
3   University Medical Center Utrecht, Gastroenterology & Hepatology, Utrecht, Netherlands
,
A Alkhalaf
4   Isala Hospital, Gastroenterology & Hepatology, Zwolle, Netherlands
,
BE Schenk
4   Isala Hospital, Gastroenterology & Hepatology, Zwolle, Netherlands
,
E Schoon
5   Catharina Hospital Eindhoven, Gastroenterology & Hepatology, Eindhoven, Netherlands
,
W Curvers
5   Catharina Hospital Eindhoven, Gastroenterology & Hepatology, Eindhoven, Netherlands
,
AD Koch
6   Erasmus Medical Center, Gastroenterology & Hepatology, Rotterdam, Netherlands
,
SEM van de Ven
6   Erasmus Medical Center, Gastroenterology & Hepatology, Rotterdam, Netherlands
,
PJF de Jonge
6   Erasmus Medical Center, Gastroenterology & Hepatology, Rotterdam, Netherlands
,
T Tang
7   IJsselland Hospital, Gastroenterology & Hepatology, Capelle a/d IJssel, Netherlands
,
WB Nagengast
8   University Medical Center Groningen, Gastroenterology & Hepatology, Groningen, Netherlands
,
FTM Peters
8   University Medical Center Groningen, Gastroenterology & Hepatology, Groningen, Netherlands
,
J Westerhof
8   University Medical Center Groningen, Gastroenterology & Hepatology, Groningen, Netherlands
,
MHMG Houben
9   Haga Hospital, Gastroenterology & Hepatology, Den Haag, Netherlands
,
JJ Bergman
2   Amsterdam University Medical Centers, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
RE Pouw
2   Amsterdam University Medical Centers, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
BLAM Weusten
1   St. Antonius Hospital, Gastroenterology & Hepatology, Nieuwegein, Netherlands
3   University Medical Center Utrecht, Gastroenterology & Hepatology, Utrecht, Netherlands
› Author Affiliations
 

Aims Although endoscopic eradication therapy (EET) with radiofrequency ablation (RFA) is effective in most Barrett’s Esophagus (BE) patients, some might experience delayed healing with visible ulcerations (“poor healing”; PH) and/or regeneration with BE mucosa (“poor squamous regeneration”; PSR). We aimed to evaluate incidence, risk factors, and outcomes of PH/PSR patients.

Methods We included all patients with ≥1 RFA from a nationwide Dutch registry consisting of all patients who underwent EET for early BE neoplasia. Treatments were performed according to a joint treatment and follow-up protocol. PH was defined as visible ulcerations ≥3 months post-RFA, PSR as <50 % regression after complete healing, and treatment success as complete eradication of BE (CE-BE).

Results 1,386 patients (median BE C2M5) underwent EET for LGD (27 %), HGD (30 %), or early cancer (43 %). PH occurred in 10 % (134/1,386) and additional time +/- acid suppression resulted in complete healing in all patients. Upon complete healing, normal squamous regeneration was seen in 50 % (67/134), 97 % of which (65/67) achieved CE-BE. PSR occurred in 5 % (74/1,386), preceded by PH in 92 % (67/74). 64 % (47/74) of PSR patients failed CE-BE, of which 30 % (14/47) had persisting neoplasia. PSR patients had a higher risk for progression to advanced cancer that exceeded boundaries for endoscopic treatment as compared to patients without PSR (15 % vs. <1 % resp., P<0.01). Risk factors for PSR: <50 % squamous regeneration after baseline endoscopic resection (OR 13.1 [95 % CI 6.8-25.9]), reflux esophagitis (OR 7.1 [2.9-16.6]), longer BE (OR 1.3 [1.2-1.4]), higher BMI (OR 1.1 [1.0-1.2]).

Table 1

Treatment characteristics

No PH or PSR

PH, no PSR

PSR ± PH

N = 1,245

N = 67

N = 74

Treatment characteristics

Treatment duration, months, median (IQR)

8 (4-13)

15 (10-20)[ * ]

14 (7-23)[ * ]

Circumferential RFA, n, mean (±SD)

0.6 (0.6)

0.8 (0.8)

1.4 (0.7)[ * ]

Pop-up lesion, n (%)

61 (5)

7 (10)

16 (22)[ * ]

Treament outcomes [ ** ]

CE-BE, n (%)

1178 (98)

65 (97)

27 (36)[ * ]

Treatment failure, n (%)

29 (2)

2 (3)

47 (64)[ * ]

Progression to advanced cancer, n (%)

6 (<1)

0 (0)

11 (15)[ * ]

* Statistically different (p-value <0.01) from no PH/PSR group after Bonferroni correction.


** Overall, in 38 patients treatment was prematurely ended due to unrelated, severe new comorbidity (n = 21), or unrelated death (n = 17).


Conclusions PH occurs in 10 % and, if managed with additional time +/- acid suppression, 50 % of patients has excellent success rates. If PSR occurs (5 %), the risk for treatment failure and progression to advanced disease is significant. Therefore, upon detection of PSR, continuation of ablative therapy should be balanced against alternative treatment options.

Citation: van Munster SN, Frederiks CN, Alvarez Herrero L et al. OP75 POOR HEALING AND POOR SQUAMOUS REGENERATION AFTER RADIOFREQUENCY ABLATION THERAPY FOR EARLY BARRETT’S NEOPLASIA: INCIDENCE, RISK FACTORS AND OUTCOMES. Endoscopy 2021; 53: S31.



Publication History

Article published online:
19 March 2021

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