title: Effect of hiatal hernia size and columnar segment length on the success of radiofrequency ablation for Barrett's esophagus: a single-center, phase II clinical trial.
abstract: OBJECTIVE
  Hiatal hernia is common in patients with Barrett's esophagus. We sought to evaluate the effect of hiatal hernia size and initial columnar segment length on the success of radiofrequency ablation of Barrett's esophagus.
  
  
  METHODS
  A phase II clinical trial was conducted aimed at evaluating the success of radiofrequency ablation in eradicating Barrett's esophagus. Success was defined as complete replacement of the columnar lining with squamous mucosa and lack of intestinal metaplasia using light microscopy. Hiatal hernia size and columnar segment length were measured endoscopically.
  
  
  RESULTS
  Sixty-seven patients were accrued to the protocol. In the 55 patients who completed radiofrequency ablation (43 successes, 12 failures), the mean hiatal hernia size was 3.3 cm (range, 0-10 cm), and the mean columnar segment length was 5.4 cm (range, 1-18 cm). The median length of the columnar segment was 3 cm in the successful cases and 8.5 cm in the failed cases (P = .002). Although the median hiatal hernia size was identical in the successful and failed cases (3 cm, P = .38), the median hiatal hernia size was 7 cm (P = .001) in the 6 patients who experienced nonhealing after the initial ablation. Patients who were successfully ablated but had larger hiatal hernias and longer columnar segment lengths required significantly more radiofrequency ablation sessions than those with smaller hernias and shorter segments (P = .003 and P = .007, respectively).
  
  
  CONCLUSIONS
  Patients with larger hiatal hernias and longer columnar segments are more likely to experience failure or nonhealing after radiofrequency ablation. These patients also require more radiofrequency ablation treatments to achieve successful eradication of Barrett's esophagus.
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ 07652, USA. korsro@valleyhealth.com
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Korst
authors.forename: Sobeida
authors.initials: S
authors.lastname: Santana-Joseph
authors.forename: John R
authors.initials: JR
authors.lastname: Rutledge
authors.forename: Arthur
authors.initials: A
authors.lastname: Antler
authors.forename: Vivian
authors.initials: V
authors.lastname: Bethala
authors.forename: Anthony
authors.initials: A
authors.lastname: DeLillo
authors.forename: Donald
authors.initials: D
authors.lastname: Kutner
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Lee
authors.forename: Haleh
authors.initials: H
authors.lastname: Pazwash
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pittman
authors.forename: Michael
authors.initials: M
authors.lastname: Rahmin
authors.forename: Mitchell
authors.initials: M
authors.lastname: Rubinoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009515:New Jersey; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014945:Wound Healing; D055815:Young Adult