Esophagus to Small Intestine
Gut. 2022;71(2):265–76
Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: Results from the national Dutch database in a 10-year period
Objective: Radiofrequency ablation (RFA) ± endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s esophagus (BE). The authors aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralized setting.
Design: Endoscopic therapy for early BE neoplasia in NL is centralized in 9 expert centers with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low-/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.
Results: After ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0–1; 1–2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly esophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analyzed for long-term outcomes. During median 43 months (22–69) and 4 endoscopies (1–5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.
Conclusion: In a setting of centralized care, radiofrequency ablation ± endoscopic resection is effective for eradication of Barrett’s related neoplasia and has remarkably low rates of dysplastic recurrence. This data support more lenient follow-up intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.