title: Prevalence of buried Barrett's metaplasia in patients before and after radiofrequency ablation.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) to treat Barrett's esophagus is increasingly accepted. Description of the etiology, natural history, and prevalence of buried Barrett's metaplasia (BBM) following RFA is limited, although BBM continues to pose a clinical dilemma. We aimed to assess the prevalence, characteristics, and eradication rate of BBM in patients with both dysplastic and nondysplastic Barrett's esophagus, treated with RFA and followed over time.
  
  
  METHODS
  The presence of Barrett's esophagus, dysplasia, and BBM, before and after RFA, was assessed by two gastrointestinal pathologists in a retrospective chart review of patients who had undergone RFA at our center and had completed appropriate follow-up.
  
  
  RESULTS
  We identified 112 patients with completed treatment and no further planned RFA. In 108, no residual Barrett's esophagus was seen after RFA; 4 patients with persistent Barrett's tissue underwent surgery. Regarding BBM, 17/112 patients (15.2%) had evidence of BBM during evaluation. In 12/17 (70.5%) BBM was found during the RFA treatment, with 8 having previously undergone non-RFA therapy and RFA for Barrett's esophagus and 4 having no previous intervention. In 5/17 (29.4%), BBM was seen only after RFA monotherapy. All 17 showed no evidence of BBM at final evaluation and were classified in the complete remission group (108/112).
  
  
  CONCLUSIONS
  Both Barrett's esophagus and BBM were completely eradicated in all patients with long-term follow-up after RFA. Almost half of the patients with BBM had a prior history of non-RFA therapy for Barrett's esophagus compared with 26% the non-BBM cohort. All patients with previously identified Barrett's esophagus and BBM were completely cleared of disease at final follow-up.
authors.affiliation: Department of Internal Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA.
authors.forename: J
authors.initials: J
authors.lastname: Yuan
authors.forename: J C
authors.initials: JC
authors.lastname: Hernandez
authors.forename: S K
authors.initials: SK
authors.lastname: Ratuapli
authors.forename: K C
authors.initials: KC
authors.lastname: Ruff
authors.forename: G
authors.initials: G
authors.lastname: De Petris
authors.forename: D M
authors.initials: DM
authors.lastname: Lam-Himlin
authors.forename: G E
authors.initials: GE
authors.lastname: Burdick
authors.forename: R
authors.initials: R
authors.lastname: Pannala
authors.forename: F C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: D E
authors.initials: DE
authors.lastname: Fleischer
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D017115:Catheter Ablation; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome