Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus

David I. Fudman; Charles J. Lightdale; John M. Poneros; Gregory G. Ginsberg; Gary W. Falk; Maureen Demarshall; Milli Gupta; Prasad G. Iyer; Lori Lutzke; Kenneth K. Wang; Julian A. Abrams

doi:10.1016/j.gie.2014.01.007

Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus

David I. Fudman, Charles J. Lightdale, John M. Poneros, Gregory G. Ginsberg, Gary W. Falk, Maureen Demarshall, Milli Gupta, Prasad G. Iyer, Lori Lutzke, Kenneth K. Wang, Julian A. Abrams

Gastroenterology and Hepatology

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes. Objective To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE. Design Retrospective analysis of longitudinal data. Setting Three tertiary-care medical centers. Patients Patients with BE treated with RFA. Intervention RFA. Main Outcome Measurements For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures. Results We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P =.014). In multivariable analysis, higher RFA volume was significantly associated with CRIM (P for trend.04). Limitations Referral setting may limit generalizability. Limited number of endoscopists analyzed. Conclusion Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.

Original language	English (US)
Pages (from-to)	71-77
Number of pages	7
Journal	Gastrointestinal endoscopy
Volume	80
Issue number	1
DOIs	https://doi.org/10.1016/j.gie.2014.01.007
State	Published - Jul 2014

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Gastroenterology

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title = "Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus",

abstract = "Background Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes. Objective To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE. Design Retrospective analysis of longitudinal data. Setting Three tertiary-care medical centers. Patients Patients with BE treated with RFA. Intervention RFA. Main Outcome Measurements For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures. Results We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P =.014). In multivariable analysis, higher RFA volume was significantly associated with CRIM (P for trend.04). Limitations Referral setting may limit generalizability. Limited number of endoscopists analyzed. Conclusion Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.",

author = "Fudman, {David I.} and Lightdale, {Charles J.} and Poneros, {John M.} and Ginsberg, {Gregory G.} and Falk, {Gary W.} and Maureen Demarshall and Milli Gupta and Iyer, {Prasad G.} and Lori Lutzke and Wang, {Kenneth K.} and Abrams, {Julian A.}",

note = "Funding Information: DISCLOSURE: This study was supported in part by the National Institutes of Health U54 award (C.J.L., J.M.P., G.G.G., G.W.F., M.D., P.G.I., L.L., K.K.W., J.A.A.; U54 CA163004) and a Career Development Award (J.A.A.; K07 CA132892) C. Lightdale is on the advisory board of CDx Diagnostics, received product royalties from Cook Medical, and is a consultant for Covidien. J. Poneros is a consultant for Boston Scientific. G. Ginsberg is a consultant for Olympus and CDx. P. Iyer received research funding from Takeda and is a consultant for Olympus. K. Wang received research support from Covidien, Pinnacle Pharmaceuticals, and CSA Medical. J. Abrams Received research support from Covidien, C2 Therapeutics, and Trio Medicines. No other financial relationships relevant to this publication were disclosed. ",

year = "2014",

month = jul,

doi = "10.1016/j.gie.2014.01.007",

language = "English (US)",

volume = "80",

pages = "71--77",

journal = "Gastrointestinal endoscopy",

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TY - JOUR

T1 - Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus

AU - Fudman, David I.

AU - Lightdale, Charles J.

AU - Poneros, John M.

AU - Ginsberg, Gregory G.

AU - Falk, Gary W.

AU - Demarshall, Maureen

AU - Gupta, Milli

AU - Iyer, Prasad G.

AU - Lutzke, Lori

AU - Wang, Kenneth K.

AU - Abrams, Julian A.

N1 - Funding Information: DISCLOSURE: This study was supported in part by the National Institutes of Health U54 award (C.J.L., J.M.P., G.G.G., G.W.F., M.D., P.G.I., L.L., K.K.W., J.A.A.; U54 CA163004) and a Career Development Award (J.A.A.; K07 CA132892) C. Lightdale is on the advisory board of CDx Diagnostics, received product royalties from Cook Medical, and is a consultant for Covidien. J. Poneros is a consultant for Boston Scientific. G. Ginsberg is a consultant for Olympus and CDx. P. Iyer received research funding from Takeda and is a consultant for Olympus. K. Wang received research support from Covidien, Pinnacle Pharmaceuticals, and CSA Medical. J. Abrams Received research support from Covidien, C2 Therapeutics, and Trio Medicines. No other financial relationships relevant to this publication were disclosed.

PY - 2014/7

Y1 - 2014/7

N2 - Background Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes. Objective To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE. Design Retrospective analysis of longitudinal data. Setting Three tertiary-care medical centers. Patients Patients with BE treated with RFA. Intervention RFA. Main Outcome Measurements For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures. Results We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P =.014). In multivariable analysis, higher RFA volume was significantly associated with CRIM (P for trend.04). Limitations Referral setting may limit generalizability. Limited number of endoscopists analyzed. Conclusion Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.

AB - Background Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes. Objective To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE. Design Retrospective analysis of longitudinal data. Setting Three tertiary-care medical centers. Patients Patients with BE treated with RFA. Intervention RFA. Main Outcome Measurements For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures. Results We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P =.014). In multivariable analysis, higher RFA volume was significantly associated with CRIM (P for trend.04). Limitations Referral setting may limit generalizability. Limited number of endoscopists analyzed. Conclusion Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.

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Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus

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