title: Safety of prior endoscopic mucosal resection in patients receiving radiofrequency ablation of Barrett's esophagus.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) is safe and effective treatment for flat dysplasia associated with Barrett's esophagus (BE). However, there are limited data on the safety of RFA in patients who had prior endoscopic mucosal resection (EMR), which might increase the risk of complications. We compared complications and histologic outcomes between patients who had EMR before RFA and those who received only RFA.
  
  
  METHODS
  We performed a retrospective analysis of data collected from patients treated for BE, associated with dysplasia or intramucosal cancer, at the Mayo Clinic in Rochester, Minnesota, from 1998-2009. Patients were divided into groups that had RFA after EMR (group 1, n = 44) or only RFA (group 2, n = 46). We compared the incidence of complications (strictures, bleeding, and esophageal perforation) and histologic features (complete resolution of dysplasia and complete resolution of intestinal metaplasia [CR-IM]) between groups. Logistic regression analysis was performed to assess predictors of stricture formation.
  
  
  RESULTS
  Stricture rates were 14% in group 1 and 9% in group 2 (odds ratio, 1.53; 95% confidence interval [CI], 0.26-9.74). The rates of CR-IM were 43% in group 1 and 74% in group 2 (odds ratio, 0.33; 95% CI, 0.14-0.78). The rates of complete resolution of dysplasia were 76% in group 1 and 71% in group 2 (odds ratio, 1.28; 95% CI, 0.39-4.17). The adjusted odds ratio for CR-IM in group 1 (adjusting for age, segment length, and grade of dysplasia) was 0.50 (95% CI, 0.15-1.66).
  
  
  CONCLUSIONS
  Stricture rates among patients who receive only RFA are comparable to those of patients who had prior EMR. EMR appears safe to perform prior to RFA.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Ngozi I
authors: NI
authors: Okoro
authors: Yutaka
authors: Y
authors: Tomizawa
authors: Kelly T
authors: KT
authors: Dunagan
authors: Lori S
authors: LS
authors: Lutzke
authors: Kenneth K
authors: KK
authors: Wang
authors: Ganapathy A
authors: GA
authors: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D004939:Esophageal Perforation / Q000453:epidemiology; D004940:Esophageal Stenosis / Q000453:epidemiology; D004947:Esophagus / Q000473:pathology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006651:Histocytochemistry; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009092:Mucous Membrane / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome