Incidence and outcomes of poor healing and poor squamous regeneration after radiofrequency ablation therapy for early Barrett's neoplasia

Abstract

Background Endoscopic eradication therapy with radiofrequency ablation (RFA) is effective in most patients with Barrett's esophagus (BE). However, some patients experience poor healing and/or poor squamous regeneration. We evaluated incidence and treatment outcomes of poor healing and poor squamous regeneration. MethodsWe included all patients treated with RFA for early BE neoplasia from a nationwide Dutch registry based on a joint treatment protocol. Poor healing (active inflammatory changes or visible ulcerations ≥ 3 months post-RFA), poor squamous regeneration (< 50% squamous regeneration), and treatment success (complete eradication of BE [CEBE]) were evaluated. Results 1386 patients (median BE C2M5) underwent RFA with baseline low grade dysplasia (27%), high grade dysplasia (30 %), or early cancer (43%). In 134 patients with poor healing (10 %), additional time and acid suppression resulted in complete esophageal healing, and 67/134 (50%) had normal squamous regeneration with 97% CE-BE. Overall, 74 patients had poor squamous regeneration (5 %). Compared with patients with normal regeneration, patients with poor squamous regeneration had a higher risk for treatment failure (64% vs. 2 %, relative risk [RR] 27 [95% confidence interval [CI] 18-40]) and progression to advanced disease (15% vs. < 1 %, RR 30 [95%CI 12-81]). Higher body mass index, longer BE segment, reflux esophagitis, and < 50% squamous regeneration after baseline endoscopic resection were independently associated with poorsquamous regeneration in multivariable logistic regression. Conclusions In half of the patients with poor healing, additional time and acid suppression led to normal squamous regeneration and excellent treatment outcomes. In patients with poor squamous regeneration, however, the risk for treatment failure and progression to advanced disease was significantly increased.