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Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study

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Abstract

Background

Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), has been validated as a safe, effective and durable treatment option for dysplastic Barrett’s esophagus. Its durability in eradicating Barrett’s-associated intramucosal carcinoma (IMC), however, is unclear. We set out to assess the long-term safety and efficacy of RFA for IMC.

Methods

Retrospective review of two tertiary care facility records for patients undergoing RFA, with or without EMR, for biopsy-proven IMC. Our primary outcome of interest was to quantify the rate of durable complete eradication for intestinal metaplasia and for IMC and associated dysplasia. A multi-variate regression analysis was performed to identify features which correlate with durable eradication of IMC/dysplasia. Our secondary outcome of interest was treatment-related complications.

Results

36 patients (26 male; mean age 64 ± 12 years), with a mean Barrett’s length of 3.5 ± 2.5 cm, underwent RFA for biopsy-proven IMC. EMR was performed in 31 (86 %) prior to or during RFA. Complete eradication of IMC/dysplasia was achieved in 32/36 (89 %) and patients required a mean of 1 ± 1 EMR and 2 ± 1 RFA sessions to achieve eradication. During a mean follow-up period of 24 ± 19 months, durable complete eradication of IMC/dysplasia was achieved in 29/36 (81 %) patients. On multi-variate regression analysis, undergoing an EMR prior to RFA was associated with an increased likelihood of maintaining durable eradication of IMC/dysplasia (p = 0.03). Treatment-related complications included: bleeding (3 %) and stricture formation (19 %).

Conclusion

RFA is an effective and durable treatment option for Barrett’s-associated IMC. Greater than 80 % of patients will achieve and maintain complete eradication of IMC at a mean of 2 years follow-up.

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Acknowledgments

Dr. Rothstein has received research support from BARRX Medical Inc.

Disclosures

Dr. Strauss, Dr. Dulai, Dr. Agoston, and Dr. Srivastava have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Adam C. Strauss, Parambir S. Dulai & Richard I. Rothstein

  2. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Agoston T. Agoston & Amitabh Srivastava

  3. Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA

    Richard I. Rothstein

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  1. Adam C. Strauss
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Correspondence to Adam C. Strauss.

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Strauss, A.C., Agoston, A.T., Dulai, P.S. et al. Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study. Surg Endosc 28, 3366–3372 (2014). https://doi.org/10.1007/s00464-014-3629-0

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