Predictors of treatment failure after radiofrequency ablation for intramucosal adenocarcinoma in barrett esophagus: A multi-institutional retrospective cohort study

Agoston T. Agoston, Adam C. Strauss, Parambir S. Dulai, Catherine E. Hagen, Alona Muzikansky, David I. Fudman, Julian A. Abrams, David G. Forcione, Kunal Jajoo, John R. Saltzman, Robert D. Odze, Gregory Y. Lauwers, Stuart R. Gordon, Charles J. Lightdale, Richard I. Rothstein, Amitabh Srivastava

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), is a safe, effective, and durable treatment option for Barrett esophagus (BE)-associated dysplasia (DYS), but few studies have identified predictors of treatment failure in BE-associated intramucosal adenocarcinoma (IMC). The aim of this study was to determine the rate of IMC eradication when using RFA±EMR and to identify clinical and pathologic predictors of treatment failure. A retrospective review of medical records and a central review of index histologic parameters were performed for 78 patients who underwent RFA±EMR as the primary treatment for biopsy-proven IMC at 4 academic tertiary medical centers. Complete eradication (CE) (absence of IMC/DYS on first follow-up endoscopy) was achieved in 86% of patients, and durable eradication (DE) (CE with no recurrence of IMC/DYS until last follow-up) was achieved in 78% of patients, with significant variation between the 4 study sites (P=0.03 and 0.09 by analysis of variance for DE and CE, respectively). Use of EMR before RFA significantly reduced the risk for treatment failure for IMC/DYS (hazard ratio, 0.15; 95% confidence interval, 0.05-0.48; P=0.001), whereas IMC involving Z50% of the columnar metaplastic area on index examination significantly increased the risk for treatment failure (hazard ratio, 4.24; 95% confidence interval, 1.53-11.7; P=0.005). Endoscopic and pathologic factors associated with treatment failure in BE-associated IMC treated with RFA± EMR may help identify the subset of IMC patients for whom a more aggressive initial approach may be justified.

Original languageEnglish (US)
Pages (from-to)554-562
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume40
Issue number4
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • Barrett esophagus
  • Endoscopic mucosal resection
  • Intramucosal adenocarcinoma
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    Agoston, A. T., Strauss, A. C., Dulai, P. S., Hagen, C. E., Muzikansky, A., Fudman, D. I., Abrams, J. A., Forcione, D. G., Jajoo, K., Saltzman, J. R., Odze, R. D., Lauwers, G. Y., Gordon, S. R., Lightdale, C. J., Rothstein, R. I., & Srivastava, A. (2016). Predictors of treatment failure after radiofrequency ablation for intramucosal adenocarcinoma in barrett esophagus: A multi-institutional retrospective cohort study. American Journal of Surgical Pathology, 40(4), 554-562. https://doi.org/10.1097/PAS.0000000000000566