Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett's Esophagus.
OBJECTIVE
Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality.


METHODS
We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality.


RESULTS
Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA.


CONCLUSIONS
Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
W Asher
WA
Wolf
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Sarina
S
Pasricha
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cary
C
Cotton
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Nan
N
Li
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
George
G
Triadafilopoulos
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.
V Raman
VR
Muthusamy
Thoracic and Cardiac Surgery, Rush University Medical Center, Chicago, Illinois.
Gary W
GW
Chmielewski
Gastroenterology Associates of Sarasota, Florida Digestive Health Specialists, Sarasota, Florida.
F Scott
FS
Corbett
Digestive Health Physicians, Cheektowaga, New York.
Daniel S
DS
Camara
Division of Digestive and Liver Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
Charles J
CJ
Lightdale
Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
Herbert
H
Wolfsen
Division of Gastroenterology, University of California Irvine, Irvine, California.
Kenneth J
KJ
Chang
Gastrointestinal Associates, Knoxville, Tennessee.
Bergein F
BF
Overholt
Nashville Gastrointestinal Associates, Nashville, Tennessee.
Ron E
RE
Pruitt
Department of Internal Medicine, University of Texas Health Medical School, Houston, Texas.
Atilla
A
Ertan
Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Srinadh
S
Komanduri
Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Anthony
A
Infantolino
Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Richard I
RI
Rothstein
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: nicholas_shaheen@med.unc.edu.
Nicholas J
NJ
Shaheen
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065840:Protective Factors; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Esophageal Adenocarcinoma; Incidence; Mortality; NDBE