Safety of Prior Endoscopic Mucosal Resection in Patients Receiving Radiofrequency Ablation of Barrett's Esophagus

Ngozi I. Okoro, Yutaka Tomizawa, Kelly T. Dunagan, Lori S. Lutzke, Kenneth Ke Ning Wang, Prasad G Iyer

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background & Aims: Radiofrequency ablation (RFA) is safe and effective treatment for flat dysplasia associated with Barrett's esophagus (BE). However, there are limited data on the safety of RFA in patients who had prior endoscopic mucosal resection (EMR), which might increase the risk of complications. We compared complications and histologic outcomes between patients who had EMR before RFA and those who received only RFA. Methods: We performed a retrospective analysis of data collected from patients treated for BE, associated with dysplasia or intramucosal cancer, at the Mayo Clinic in Rochester, Minnesota, from 1998-2009. Patients were divided into groups that had RFA after EMR (group 1, n = 44) or only RFA (group 2, n = 46). We compared the incidence of complications (strictures, bleeding, and esophageal perforation) and histologic features (complete resolution of dysplasia and complete resolution of intestinal metaplasia [CR-IM]) between groups. Logistic regression analysis was performed to assess predictors of stricture formation. Results: Stricture rates were 14% in group 1 and 9% in group 2 (odds ratio, 1.53; 95% confidence interval [CI], 0.26-9.74). The rates of CR-IM were 43% in group 1 and 74% in group 2 (odds ratio, 0.33; 95% CI, 0.14-0.78). The rates of complete resolution of dysplasia were 76% in group 1 and 71% in group 2 (odds ratio, 1.28; 95% CI, 0.39-4.17). The adjusted odds ratio for CR-IM in group 1 (adjusting for age, segment length, and grade of dysplasia) was 0.50 (95% CI, 0.15-1.66). Conclusions: Stricture rates among patients who receive only RFA are comparable to those of patients who had prior EMR. EMR appears safe to perform prior to RFA.

Original languageEnglish (US)
Pages (from-to)150-154
Number of pages5
JournalClinical Gastroenterology and Hepatology
Volume10
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Barrett Esophagus
Safety
Pathologic Constriction
Metaplasia
Odds Ratio
Confidence Intervals
Esophageal Perforation
Endoscopic Mucosal Resection
Logistic Models
Regression Analysis
Hemorrhage
Incidence
Neoplasms

Keywords

  • Ablation Techniques
  • Barrett's Esophagus
  • Endoscopy
  • Esophageal Neoplasms

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Safety of Prior Endoscopic Mucosal Resection in Patients Receiving Radiofrequency Ablation of Barrett's Esophagus. / Okoro, Ngozi I.; Tomizawa, Yutaka; Dunagan, Kelly T.; Lutzke, Lori S.; Wang, Kenneth Ke Ning; Iyer, Prasad G.

In: Clinical Gastroenterology and Hepatology, Vol. 10, No. 2, 02.2012, p. 150-154.

Research output: Contribution to journalArticle

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abstract = "Background & Aims: Radiofrequency ablation (RFA) is safe and effective treatment for flat dysplasia associated with Barrett's esophagus (BE). However, there are limited data on the safety of RFA in patients who had prior endoscopic mucosal resection (EMR), which might increase the risk of complications. We compared complications and histologic outcomes between patients who had EMR before RFA and those who received only RFA. Methods: We performed a retrospective analysis of data collected from patients treated for BE, associated with dysplasia or intramucosal cancer, at the Mayo Clinic in Rochester, Minnesota, from 1998-2009. Patients were divided into groups that had RFA after EMR (group 1, n = 44) or only RFA (group 2, n = 46). We compared the incidence of complications (strictures, bleeding, and esophageal perforation) and histologic features (complete resolution of dysplasia and complete resolution of intestinal metaplasia [CR-IM]) between groups. Logistic regression analysis was performed to assess predictors of stricture formation. Results: Stricture rates were 14{\%} in group 1 and 9{\%} in group 2 (odds ratio, 1.53; 95{\%} confidence interval [CI], 0.26-9.74). The rates of CR-IM were 43{\%} in group 1 and 74{\%} in group 2 (odds ratio, 0.33; 95{\%} CI, 0.14-0.78). The rates of complete resolution of dysplasia were 76{\%} in group 1 and 71{\%} in group 2 (odds ratio, 1.28; 95{\%} CI, 0.39-4.17). The adjusted odds ratio for CR-IM in group 1 (adjusting for age, segment length, and grade of dysplasia) was 0.50 (95{\%} CI, 0.15-1.66). Conclusions: Stricture rates among patients who receive only RFA are comparable to those of patients who had prior EMR. EMR appears safe to perform prior to RFA.",
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AU - Wang, Kenneth Ke Ning

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