ORLANDO – Age, race, and extent of disease treated appear to predict which patients will have a recurrence of Barrett’s esophagus after apparently successful radiofrequency ablation, investigators reported at the annual Digestive Disease Week.
A review of registry data from 148 centers in the United States shows that patients who experience a recurrence of Barrett’s after radiofrequency ablation (RFA) are more likely to be older, to be nonwhite, and to have had larger areas of involvement treated and fewer treatment sessions than patients with no recurrence, said Dr. William J. Bulsiewicz, of the University of North Carolina in Chapel Hill.
"These risk factors may point out biological differences between the populations [with Barrett’s] and help us to better understand the process of regeneration of squamous epithelium," he said.
There were recurrences in 28% of 1,602 patients who had complete eradication of intestinal metaplasia with RFA for Barrett’s and had at least 2 years of follow-up during which at least two biopsies were performed. The median time to recurrence was 1.4 years. Additionally, 33 patients were retreated for a suspected recurrence despite a lack of histological confirmation.
Based on a bivariate analysis of characteristics, patients with recurrent disease were more likely to have a higher mean age (63 vs. 61 years, P less than .01), to be male (77% vs. 71%, P = .03), to have longer esophageal segments with disease involvement (mean 4.3 vs. 3.7 cm, P less than .01), and to have low-grade dysplasia or worse prior to treatment (54% vs. 45%, P less than. 01).
The researchers used these and other patient and treatment characteristics in a logistic regression model to see which factors, if any, could independently predict recurrence.
Significant independent predictors of recurrence included nonwhite race (odds ratio, 2.47), length of the tubular esophagus with Barrett’s esophagus (OR, 1.09 per centimeter), age (OR, 1.02 per year), and number of RFA sessions required to treat initial disease (OR, 0.90 per treatment session).
Risk of recurrence was not associated with sex, pretreatment dysplasias, previous endoscopic mucosal resection, or treatment setting (academic medical center vs. community setting), Dr. Bulsiewicz said.
The investigators suggested that future surveillance protocols include age, race, esophageal length of Barrett’s involvement, and number of treatment sessions.
The study was funded by Covidien, GI Solutions, and the National Institutes of Health. Dr. Bulsiewicz reported having no financial disclosures.
