title: Radiofrequency ablation for Barrett's-associated intramucosal carcinoma: a multi-center follow-up study.
abstract: BACKGROUND
  Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), has been validated as a safe, effective and durable treatment option for dysplastic Barrett's esophagus. Its durability in eradicating Barrett's-associated intramucosal carcinoma (IMC), however, is unclear. We set out to assess the long-term safety and efficacy of RFA for IMC.
  
  
  METHODS
  Retrospective review of two tertiary care facility records for patients undergoing RFA, with or without EMR, for biopsy-proven IMC. Our primary outcome of interest was to quantify the rate of durable complete eradication for intestinal metaplasia and for IMC and associated dysplasia. A multi-variate regression analysis was performed to identify features which correlate with durable eradication of IMC/dysplasia. Our secondary outcome of interest was treatment-related complications.
  
  
  RESULTS
  36 patients (26 male; mean age 64 ± 12 years), with a mean Barrett's length of 3.5 ± 2.5 cm, underwent RFA for biopsy-proven IMC. EMR was performed in 31 (86%) prior to or during RFA. Complete eradication of IMC/dysplasia was achieved in 32/36 (89%) and patients required a mean of 1 ± 1 EMR and 2 ± 1 RFA sessions to achieve eradication. During a mean follow-up period of 24 ± 19 months, durable complete eradication of IMC/dysplasia was achieved in 29/36 (81%) patients. On multi-variate regression analysis, undergoing an EMR prior to RFA was associated with an increased likelihood of maintaining durable eradication of IMC/dysplasia (p = 0.03). Treatment-related complications included: bleeding (3%) and stricture formation (19%).
  
  
  CONCLUSIONS
  RFA is an effective and durable treatment option for Barrett's-associated IMC. Greater than 80% of patients will achieve and maintain complete eradication of IMC at a mean of 2 years follow-up.
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, adam.c.strauss@hitchcock.org.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Strauss
authors.forename: Agoston T
authors.initials: AT
authors.lastname: Agoston
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.forename: Amitabh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D017115:Catheter Ablation; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome