title: Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes.
  
  
  OBJECTIVE
  To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE.
  
  
  METHODS
  Retrospective analysis of longitudinal data.
  
  
  METHODS
  Three tertiary-care medical centers.
  
  
  METHODS
  Patients with BE treated with RFA.
  For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures.
  
  
  RESULTS
  We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P = .014). In multivariable analysis, higher RFA volume was significantly associated with CRIM (P for trend .04).
  
  
  CONCLUSIONS
  Referral setting may limit generalizability. Limited number of endoscopists analyzed.
  
  
  CONCLUSIONS
  Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
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, USA.
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, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Poneros
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Demarshall
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Milli
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Lutzke
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome