title: Prior fundoplication does not improve safety or efficacy outcomes of radiofrequency ablation: results from the U.S. RFA Registry.
abstract: BACKGROUND
  Ongoing gastroesophageal reflux may impair healing and re-epithelialization after radiofrequency ablation (RFA) of Barrett's esophagus (BE). Because prior fundoplication may improve reflux control, our aim was to assess the relationship between prior fundoplication and the safety/efficacy of RFA.
  
  
  METHODS
  We assessed the U.S. RFA Registry, a nationwide registry of BE patients receiving RFA at 148 institutions, to compare the safety and efficacy of ablation between those with prior fundoplication and those with medical management (proton pump inhibition).
  
  
  RESULTS
  Among 5,537 patients receiving RFA, 301 (5.4 %) had prior fundoplication. Of fundoplication subjects, 1.0 % developed stricture and 1.0 % were hospitalized after RFA. Rates of stricture, bleeding, and hospitalization were not statistically different (p = ns) between patients with and without prior fundoplication. Complete eradication of intestinal metaplasia and complete eradication of dysplasia were achieved in 71 % and 87 % of fundoplication patients, and 73 % and 87 % of patients without fundoplication, respectively (p = ns for both). Patients with prior fundoplication needed similar numbers of RFA sessions for eradication compared with those without fundoplication.
  
  
  CONCLUSIONS
  Radiofrequency ablation, with or without prior fundoplication, is safe and effective in eradicating BE. Prior fundoplication was associated with similar adverse event and efficacy rates when compared with medical management.
authors.affiliation: University of North Carolina School of Medicine, 130 Mason Farm Rd, CB#7080, Chapel Hill, NC 27599-7080, USA. nicholas_shaheen@med.unc.edu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Hannah P
authors.initials: HP
authors.lastname: Kim
authors.forename: William J
authors.initials: WJ
authors.lastname: Bulsiewicz
authors.forename: William D
authors.initials: WD
authors.lastname: Lyday
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chmielewski
authors.forename: Atilla
authors.initials: A
authors.lastname: Ertan
authors.forename: F Scott
authors.initials: FS
authors.lastname: Corbett
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Camara
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
authors.forename: Bergein F
authors.initials: BF
authors.lastname: Overholt
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D054328:Proton Pump Inhibitors