title: Eosinophilic infiltration of the esophagus following endoscopic ablation of Barrett's neoplasia.
abstract: To assess the incidence of esophageal intra-epithelial eosinophilic infiltration following endoscopic ablation of Barrett's esophagus (BE), a retrospective study of consecutive cases of endoscopic ablation of BE with dysplasia or cancer using radiofrequency ablation (RFA) and spray cryotherapy at two centers in the United States was performed. Post-ablation eosinophilia was defined as ≥ 5 eosinophils per high power field during post-treatment surveillance. Twenty of 122 patients (16%) undergoing ablation developed esophageal eosinophilia after ablation, including 8/77 (10%) treated with RFA and 12/44 (27%) treated with cryotherapy. No patient had clinical or endoscopic findings of or risk factors for eosinophilic esophagitis. Esophageal eosinophilia persisted in 30% over a median of 20.2 months. On multivariate analysis, post-ablation eosinophilia was independently associated with increasing BE segment length (adjusted odds ratio 1.46 for every 2-cm increase, 95% confidence interval 1.24-1.71) and cryotherapy as the ablation modality (adjusted odds ratio 5.23, 95% confidence interval 1.67-16.39). Esophageal eosinophilic infiltration after endoscopic ablation with RFA and cryotherapy is common and is associated with the BE segment length and treatment modality. The clinical significance of post-ablation eosinophilia is unclear.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Halsey
authors.forename: M
authors.initials: M
authors.lastname: Arora
authors.forename: W J
authors.initials: WJ
authors.lastname: Bulsiewicz
authors.forename: J
authors.initials: J
authors.lastname: Heath
authors.forename: B
authors.initials: B
authors.lastname: Petullo
authors.forename: R D
authors.initials: RD
authors.lastname: Madanick
authors.forename: E S
authors.initials: ES
authors.lastname: Dellon
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: B D
authors.initials: BD
authors.lastname: Greenwald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome