title: Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett's esophagus: results from a US Multicenter Consortium.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett's esophagus (BE). Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA.
  
  
  METHODS
  We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastroesophageal junction biopsy specimens), documented by 2 consecutive endoscopies. Recurrence was defined as the presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings.
  
  
  RESULTS
  Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic BE. Of patients treated, 448 (76%) were assessed after RFA. Fifty-five percent of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication.
  
  
  CONCLUSIONS
  Of patients with BE treated by RFA, 56% were in complete remission after 24 months. However, 33% of these patients had disease recurrence within the next 2 years. Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after RFA is essential.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Milli
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: iyer.prasad@mayo.edu.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lori
authors.initials: L
authors.lastname: Lutzke
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Emmanuel C
authors.initials: EC
authors.lastname: Gorospe
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Rustgi
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Wang
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.
authors.forename: David I
authors.initials: DI
authors.lastname: Fudman
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.
authors.forename: John M
authors.initials: JM
authors.lastname: Poneros
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D004943:Esophagogastric Junction / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D012008:Recurrence