Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus

W. Asher Wolf, Sarina Pasricha, Cary Cotton, Nan Li, George Triadafilopoulos, V. Raman Muthusamy, Gary W. Chmielewski, F. Scott Corbett, Daniel S. Camara, Charles J. Lightdale, Herbert Wolfsen, Kenneth J. Chang, Bergein F. Overholt, Ron E. Pruitt, Atilla Ertan, Srinadh Komanduri, Anthony Infantolino, Richard I. Rothstein, Nicholas J. Shaheen

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Abstract

Background & Aims 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.

Original languageEnglish (US)
Pages (from-to)1752-1761e1
JournalGastroenterology
Volume149
Issue number7
DOIs
StatePublished - Dec 1 2015

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Barrett Esophagus
Adenocarcinoma
Mortality
Incidence
Logistic Models
Registries
Histology
Odds Ratio

Keywords

  • Esophageal Adenocarcinoma
  • Incidence
  • Mortality
  • NDBE

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wolf, W. A., Pasricha, S., Cotton, C., Li, N., Triadafilopoulos, G., Muthusamy, V. R., ... Shaheen, N. J. (2015). Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. Gastroenterology, 149(7), 1752-1761e1. https://doi.org/10.1053/j.gastro.2015.08.048

Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. / Wolf, W. Asher; Pasricha, Sarina; Cotton, Cary; Li, Nan; Triadafilopoulos, George; Muthusamy, V. Raman; Chmielewski, Gary W.; Corbett, F. Scott; Camara, Daniel S.; Lightdale, Charles J.; Wolfsen, Herbert; Chang, Kenneth J.; Overholt, Bergein F.; Pruitt, Ron E.; Ertan, Atilla; Komanduri, Srinadh; Infantolino, Anthony; Rothstein, Richard I.; Shaheen, Nicholas J.

In: Gastroenterology, Vol. 149, No. 7, 01.12.2015, p. 1752-1761e1.

Research output: Contribution to journalArticle

Wolf, WA, Pasricha, S, Cotton, C, Li, N, Triadafilopoulos, G, Muthusamy, VR, Chmielewski, GW, Corbett, FS, Camara, DS, Lightdale, CJ, Wolfsen, H, Chang, KJ, Overholt, BF, Pruitt, RE, Ertan, A, Komanduri, S, Infantolino, A, Rothstein, RI & Shaheen, NJ 2015, 'Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus', Gastroenterology, vol. 149, no. 7, pp. 1752-1761e1. https://doi.org/10.1053/j.gastro.2015.08.048
Wolf, W. Asher ; Pasricha, Sarina ; Cotton, Cary ; Li, Nan ; Triadafilopoulos, George ; Muthusamy, V. Raman ; Chmielewski, Gary W. ; Corbett, F. Scott ; Camara, Daniel S. ; Lightdale, Charles J. ; Wolfsen, Herbert ; Chang, Kenneth J. ; Overholt, Bergein F. ; Pruitt, Ron E. ; Ertan, Atilla ; Komanduri, Srinadh ; Infantolino, Anthony ; Rothstein, Richard I. ; Shaheen, Nicholas J. / Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. In: Gastroenterology. 2015 ; Vol. 149, No. 7. pp. 1752-1761e1.
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AU - Wolf, W. Asher

AU - Pasricha, Sarina

AU - Cotton, Cary

AU - Li, Nan

AU - Triadafilopoulos, George

AU - Muthusamy, V. Raman

AU - Chmielewski, Gary W.

AU - Corbett, F. Scott

AU - Camara, Daniel S.

AU - Lightdale, Charles J.

AU - Wolfsen, Herbert

AU - Chang, Kenneth J.

AU - Overholt, Bergein F.

AU - Pruitt, Ron E.

AU - Ertan, Atilla

AU - Komanduri, Srinadh

AU - Infantolino, Anthony

AU - Rothstein, Richard I.

AU - Shaheen, Nicholas J.

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N2 - Background & Aims 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.

AB - Background & Aims 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.

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