title: Incidence and predictors of adenocarcinoma following endoscopic ablation of Barrett's esophagus.
abstract: BACKGROUND
  The rate and risk factors of recurrent or metachronous adenocarcinoma following endoscopic ablation therapy in patients with Barrett's esophagus (BE) have not been specifically reported.
  
  
  OBJECTIVE
  The aim of this study was to determine the incidence and predictors of adenocarcinoma after ablation therapy for BE high-grade dysplasia (HGD) or intramucosal carcinoma (IMC).
  
  
  METHODS
  This is a single center, retrospective review of prospectively collected data on consecutive cases of endoscopic ablation for BE. A total of 223 patients with BE (HGD or IMC) were treated by ablation between 1996 and 2011. Primary outcome measures were recurrence and new development of adenocarcinoma after ablation. Recurrence was defined as the presence of adenocarcinoma following the absence of adenocarcinoma in biopsy samples from two consecutive surveillance endoscopies. Logistic regression analysis was performed to assess predictors of adenocarcinoma after ablation.
  
  
  RESULTS
  One hundred and eighty-three patients were included in the final analysis, and 40 patients were excluded: 22 for palliative ablation, eight lost to follow-up, five for residual carcinoma and five for postoperative state. Median follow-up was 39 months. Recurrence or new development of adenocarcinoma was found in 20 patients (11 %) and the median time to recurrence/development of adenocarcinoma was 11.5 months. Independent predictors of recurrent or metachronous adenocarcinoma were hiatal hernia size ≥ 4 cm (odds ratio 3.649, P = 0.0233) and histology (HGD/adenocarcinoma) after first ablation (odds ratio 4.141, P = 0.0065).
  
  
  CONCLUSIONS
  Adenocarcinoma after endoscopic therapy for HGD or IMC in BE is associated with large hiatal hernia and histology status after initial ablation therapy.
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, USA, kyasuda@oita-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasuda
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Choi
authors.forename: Norman S
authors.initials: NS
authors.lastname: Nishioka
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.forename: William P
authors.initials: WP
authors.lastname: Puricelli
authors.forename: Angela C
authors.initials: AC
authors.lastname: Tramontano
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome