Digestive Diseases and Sciences

, Volume 59, Issue 7, pp 1560–1566

Incidence and Predictors of Adenocarcinoma Following Endoscopic Ablation of Barrett’s Esophagus

  • Kazuhiro Yasuda
  • Sung Eun Choi
  • Norman S. Nishioka
  • David W. Rattner
  • William P. Puricelli
  • Angela C. Tramontano
  • Seigo Kitano
  • Chin Hur
Original Article



The rate and risk factors of recurrent or metachronous adenocarcinoma following endoscopic ablation therapy in patients with Barrett’s esophagus (BE) have not been specifically reported.


The aim of this study was to determine the incidence and predictors of adenocarcinoma after ablation therapy for BE high-grade dysplasia (HGD) or intramucosal carcinoma (IMC).


This is a single center, retrospective review of prospectively collected data on consecutive cases of endoscopic ablation for BE. A total of 223 patients with BE (HGD or IMC) were treated by ablation between 1996 and 2011. Primary outcome measures were recurrence and new development of adenocarcinoma after ablation. Recurrence was defined as the presence of adenocarcinoma following the absence of adenocarcinoma in biopsy samples from two consecutive surveillance endoscopies. Logistic regression analysis was performed to assess predictors of adenocarcinoma after ablation.


One hundred and eighty-three patients were included in the final analysis, and 40 patients were excluded: 22 for palliative ablation, eight lost to follow-up, five for residual carcinoma and five for postoperative state. Median follow-up was 39 months. Recurrence or new development of adenocarcinoma was found in 20 patients (11 %) and the median time to recurrence/development of adenocarcinoma was 11.5 months. Independent predictors of recurrent or metachronous adenocarcinoma were hiatal hernia size ≥ 4 cm (odds ratio 3.649, P = 0.0233) and histology (HGD/adenocarcinoma) after first ablation (odds ratio 4.141, P = 0.0065).


Adenocarcinoma after endoscopic therapy for HGD or IMC in BE is associated with large hiatal hernia and histology status after initial ablation therapy.


Barrett’s esophagus Adenocarcinoma Recurrence Ablation techniques Endoscopy 


  1. 1.
    Drewitz DJ, Sampliner RE, Garewal HS. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years. Am J Gastroenterol. 1997;92:212–215.PubMedGoogle Scholar
  2. 2.
    Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus? Gastroenterology. 2000;119:587–589.CrossRefGoogle Scholar
  3. 3.
    Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: meta-analysis. Gastrointest Endosc. 2008;67:394–398.CrossRefPubMedGoogle Scholar
  4. 4.
    Provenzale D, Schmitt C, Wong JB. Barrett’s esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999;94:2043–2053.CrossRefPubMedGoogle Scholar
  5. 5.
    Eloubeidi MA, Mason AC, Desmond RA, et al. Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol. 2003;98:1627–1633.PubMedGoogle Scholar
  6. 6.
    Portale G, Peters JH, Hagen JA, et al. Comparison of the clinical and histological characteristics and survival of distal esophageal-gastroesophageal junction adenocarcinoma in patients with and without Barrett mucosa. Arch Surg. 2005;140:570–574.CrossRefPubMedGoogle Scholar
  7. 7.
    Overholt BF, Lightdale CJ, Wang KK, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc. 2005;62:488–498.CrossRefPubMedGoogle Scholar
  8. 8.
    Ganz RA, Overholt BF, Sharma VK, et al. Circumferantial ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. multicenter registry. Gastrointest Endosc. 2008;68:35–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Yachimski P, Puricelli WP, Nishioka NS. Patient predictors of histopathologic response after photodynamic therapy of Barrett’s esophagus with high-grade dysplasia or intramucoal carcinoma. Gastrointest Endosc.. 2009;69:205–212.CrossRefPubMedGoogle Scholar
  10. 10.
    Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. New Engl J Med. 2009;360:2277–2288.CrossRefPubMedGoogle Scholar
  11. 11.
    Hur C, Choi SE, Rubenstein JH, et al. The cost effectiveness of radiofrequency ablation for Barrett’s esophagus. Gastroenterology 2012 May 21 [Epub ahead of print].Google Scholar
  12. 12.
    Haidry RJ, Dunn JM, Butt MA, et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrett’s esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology. 2013;145:87–95.CrossRefPubMedGoogle Scholar
  13. 13.
    Phoa KN, Pouw RE, van Vilsteren FG, et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands Cohort Study. Gastroenterology. 2013;145(1):96–104.CrossRefPubMedGoogle Scholar
  14. 14.
    Gupta M, Iyer PG, Lutzke L, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US Multicenter Consortium. Gastroenterology. 2013;145(1):79–862.CrossRefPubMedGoogle Scholar
  15. 15.
    American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011;140:1084–1091.Google Scholar
  16. 16.
    Wani S, Puli SR, Shaheen NJ, et al. Esophageal adenocarcinoma in Barrett’s esophagus after endoscopic ablative therapy: a meta-analysis and systematic review. Am J Gastroenterol. 2009;104:502–513.CrossRefPubMedGoogle Scholar
  17. 17.
    Badreddine RJ, Prasad GA, Wang KK, et al. Prevalence and predictors of recurrent neoplasia after ablation of Barrett’s esophagus. Gastrointest Endosc. 2010;71:697–703.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Yachimsky P, Puricelli WP, Nishioka NS. Patient predictors of esophageal stricture development after photodynamic therapy. Clin Gastroenterol Hepatol. 2008;6:302–308.CrossRefGoogle Scholar
  19. 19.
    Menon D, Stafinski T, Wu H, et al. Endoscopic treatments for Barrett’s esophagus: a systematic review of safety and effectiveness compared to esophagectomy. BMC Gastroenterol. 2010;10:111.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s esophagus. Gut. 2008;57:1200–1206.CrossRefPubMedGoogle Scholar
  21. 21.
    Avidan B, Sonnenberg A, Schnell TG, et al. Hiatal hernia size, Barrett’s length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol. 2002;97:1930–1936.CrossRefPubMedGoogle Scholar
  22. 22.
    Weston AP, Sharma P, Mathur S, et al. Risk stratification of Barrett’s esophagus: updated prospective multivariate analysis. Am J Gastroenterol. 2004;99:1657–1666.CrossRefPubMedGoogle Scholar
  23. 23.
    Weston AP, Badr AS, Hassanein RS. Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett’s multifocal high-grade dysplasia or adenocarcinoma. Am J Gastroenterol. 1999;94:3413–3419.CrossRefPubMedGoogle Scholar
  24. 24.
    Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–831.CrossRefPubMedGoogle Scholar
  25. 25.
    Hillman LC, Chiragakis L, Shadbolt B, et al. Effect of proton pump inhibitors on markers of risk for high-grade dysplasia and oesophageal cancer in Barrett’s oesophagus. Aliment Pharmacol Ther. 2008;27:321–326.CrossRefPubMedGoogle Scholar
  26. 26.
    Kuipers EJ. Barrett’s oesophagus, proton inhibitors and gastric: the fog is clearing. Gut. 2010;59:148–149.CrossRefPubMedGoogle Scholar
  27. 27.
    Fitzgerald RC, Omary MB, Triadafilopoulos G. Dynamic effects of acid on Barrett’s esophagus: an ex vivo proliferation and differentiation model. J Clin Invest.. 1996;98:2120–2128.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256:95–103.CrossRefPubMedGoogle Scholar
  29. 29.
    Dunki-Jacobs EM, Martin RC. Endoscopic therapy for Barrett’s esophagus: a review of its emerging role in optimal diagnosis and endoluminal therapy. Ann Surg Oncol. 2012;19:1575–1582.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kazuhiro Yasuda
    • 1
    • 4
  • Sung Eun Choi
    • 2
  • Norman S. Nishioka
    • 3
  • David W. Rattner
    • 1
  • William P. Puricelli
    • 3
  • Angela C. Tramontano
    • 2
  • Seigo Kitano
    • 5
  • Chin Hur
    • 2
    • 3
  1. 1.Division of General and Gastrointestinal SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Institute for Technology AssessmentMassachusetts General HospitalBostonUSA
  3. 3.Gastrointestinal UnitMassachusetts General HospitalBostonUSA
  4. 4.Department of Gastroenterological and Pediatric Surgery, Faculty of MedicineOita UniversityOitaJapan
  5. 5.Oita UniversityOitaJapan

Personalised recommendations