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

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.