Comparison of Safety, Efficacy, and Long-term Outcomes of Radiofrequency Ablation (RFA) for Treatment of Dysplastic Barrettʼs in a Low-Volume Center Compared to Published Standards from High-Volume Centers

Abstract

Introduction: Radiofrequency ablation (RFA) is an established treatment modality for Barrett's esophagus with dysplasia (BE-D), favored given its cost effectiveness, low recurrence and adverse event rates, and greater patient satisfaction. Although it is practiced universally, comparative data between low-volume versus high-volume centers is lacking. The aim of our study is to evaluate safety, efficacy and long term outcomes of RFA in a low-volume center, and compare it to existing published values from highvolume centers, in an attempt to improve quality and establish better practice standards. Methods: Our IRB approved retrospective study involved all patients enrolled in Barrett's RFA program at our institution between 2010 and 2014. Results: A total of 24 patients were identified, but data on 4 was partly unavailable due to change of endoscopy software during this period, and were hence excluded.Charts of 20 patients (M: F=18:2, Caucasian:Black=16:4) were finally reviewed. The common symptoms for EGD referral included heartburn (85%), water brash (15%), dysphagia (15%), nausea (10%) and GI bleeding (10%). The biopsies showed high-grade dysplasia (HGD) in 10, low-grade dysplasia (LGD) in 9 and one patient had mix of LGD-HGD. 4/20 patients had nodules, who underwent EMR but none had adenocarcinoma. No other treatment was attempted on any of these patients before RFA. The number of RFA sessions needed for complete resolution of BE was variable - 1 session (1 patient), 2 sessions (7 patients), 3 sessions (5 patients), 4 sessions (4 patients), 5 sessions (1 patient) and 6 sessions (1 patient). One patient was lost to follow-up after 5thsession. Circumferential ablation was used in 80% of the patients in first round, 14% in second round and only focal therapy was needed in patients after that. The RFA treatments were welltolerated, with transient nausea being the commonest post-procedure complaint (50%), followed by mild chest discomfort and dysphagia (16.7%). None of the patients had any serious complications including perforation or bleeding. None of the patients developed adenocarcinoma of the esophagus during the course of follow-up till date. Conclusion: RFA was found to be safe and equally efficacious in a low-volume center, as is in highvolume centers, and long term outcomes were reassuring. These results call for greater use of RFA in management of dysplastic BE, in non-referral centers also.