title: Durability and predictors of successful radiofrequency ablation for Barrett's esophagus.
abstract: OBJECTIVE
  After radiofrequency ablation (RFA), patients may experience recurrence of Barrett's esophagus (BE) after complete eradication of intestinal metaplasia (CEIM). Rates and predictors of recurrence after successful eradication have been poorly described.
  
  
  METHODS
  We used the US RFA Registry, a nationwide registry of BE patients receiving RFA, to determine rates and factors that predicted recurrence of intestinal metaplasia (IM). We assessed recurrence by Kaplan-Meier analysis for the overall cohort and by worst pretreatment histology. Characteristics associated with recurrence were included in a logistic regression model to identify independent predictors.
  
  
  RESULTS
  Among 5521 patients, 3728 had biopsies 12 months or more after initiation of RFA. Of these, 3169 (85%) achieved CEIM, and 1634 (30%) met inclusion criteria. The average follow-up period was 2.4 years after CEIM. IM recurred in 334 (20%) and was nondysplastic or indefinite for dysplasia in 86% (287 of 334); the average length of recurrent BE was 0.6 cm. In Kaplan-Meier analysis, more advanced pretreatment histology was associated with an increased yearly recurrence rate. Compared with patients without recurrence, patients with recurrence were more likely, based on bivariate analysis, to be older, have longer BE segments, be non-Caucasian, have dysplastic BE before treatment, and require more treatment sessions. In multivariate analysis, the likelihood for recurrence was associated with increasing age and BE length, and non-Caucasian race.
  
  
  CONCLUSIONS
  BE recurred in 20% of patients followed up for an average of 2.4 years after CEIM. Most recurrences were short segments and were nondysplastic or indefinite for dysplasia. Older age, non-Caucasian race, and increasing length of BE length were all risk factors. These risk factors should be considered when planning post-RFA surveillance intervals.
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sarina
authors.initials: S
authors.lastname: Pasricha
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: William J
authors.initials: WJ
authors.lastname: Bulsiewicz
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Hathorn
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University School of Medicine, Chicago, Illinois.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.affiliation: Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.affiliation: Division of Gastroenterology and Hepatology, Dartmouth University School of Medicine, Hanover, New Hampshire.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.affiliation: Division of Gastroenterology and Hepatology, Columbia University School of Medicine, New York, New York.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
authors.affiliation: Gastrointestinal Associates, Knoxville, Tennessee.
authors.forename: Bergein F
authors.initials: BF
authors.lastname: Overholt
authors.affiliation: Digestive Health Physicians, Cheektowaga, New York.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Camara
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.affiliation: Atlanta Gastroenterology Associates, Atlanta, Georgia.
authors.forename: William D
authors.initials: WD
authors.lastname: Lyday
authors.affiliation: Division of Gastroenterolgy and Hepatology, University of Texas School of Medicine, Houston, Texas.
authors.forename: Atilla
authors.initials: A
authors.lastname: Ertan
authors.affiliation: Division of Thoracic Surgery, Rush Medical College, Chicago, Illinois.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chmielewski
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: nicholas_shaheen@med.unc.edu.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000517:prevention & control / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: Adenocarcinoma; EAC; Esophageal Cancer; Risk Factors