Prevalence of buried Barretts metaplasia in patients before and after radiofrequency ablation

Background and study aim: Radiofrequency ablation (RFA) to treat Barretts esophagus is increasingly accepted. Description of the etiology, natural history, and prevalence of buried Barretts metaplasia (BBM) following RFA is limited, although BBM continues to pose a clinical dilemma. We aimed to assess the prevalence, characteristics, and eradication rate of BBM in patients with both dysplastic and nondysplastic Barretts esophagus, treated with RFA and followed over time. Patients and methods: The presence of Barretts esophagus, dysplasia, and BBM, before and after RFA, was assessed by two gastrointestinal pathologists in a retrospective chart review of patients who had undergone RFA at our center and had completed appropriate follow-up. Results: We identified 112 patients with completed treatment and no further planned RFA. In 108, no residual Barretts esophagus was seen after RFA; 4 patients with persistent Barretts tissue underwent surgery. Regarding BBM, 17/112 patients (15.2%) had evidence of BBM during evaluation. In 12/17 (70.5%) BBM was found during the RFA treatment, with 8 having previously undergone non-RFA therapy and RFA for Barretts esophagus and 4 having no previous intervention. In 5/17 (29.4%), BBM was seen only after RFA monotherapy. All 17 showed no evidence of BBM at final evaluation and were classified in the complete remission group (108/112). Conclusion: Both Barretts esophagus and BBM were completely eradicated in all patients with long-term follow-up after RFA. Almost half of the patients with BBM had a prior history of non-RFA therapy for Barretts esophagus compared with 26% the non-BBM cohort. All patients with previously identified Barretts esophagus and BBM were completely cleared of disease at final follow-up.