Site Volume is Inversely Associated With Recurrence Rate After Successful Radiofrequency Ablation (RFA): An Analysis of the U.S. RFA Registry

Abstract

Introduction: Factors associated with recurrent Barrett’s esophagus (BE) after successful eradication are poorly understood. We used the U.S. RFA registry to assess the relationship between site volume and recurrence of intestinal metaplasia (IM) in the U.S. RFA registry. Methods: The U.S. RFA registry is a national study of patients with BE treated with RFA at 148 institutions (113 community-based, 35 academic). We assessed the rate of recurrence of IM after initial complete eradication of IM. We divided the sites into quintiles by number of registry subjects enrolled, such that those in the 1st quintile enrolled ≤7 patients, while those in the 5th quintile enrolled ≥56. We used Kaplan-Meier estimation and proportional hazards models to assess the association of site volume with the rate of recurrence of IM.Figure 1Results: Recurrence of IM occurred at a higher rate in smaller centers (Table 1). For each increase in quintile, the hazard ratio (HR) for recurrence was 0.70 [0.64, 0.77]. The HR was somewhat attenuated, but persisted, after adjustment for initial histology, academic vs. community, race/ethnicity, BE length, age, and order treated (aHR = 0.81 [0.72, 0.90]).Table 1: Characteristics of 2072 Patients at 148 RFA Sites by Quintile of VolumeConclusion: There is a strong association between site volume and the rate of recurrence of intestinal metaplasia after initially successful RFA, with smaller volume sites demonstrating higher recurrence rates. This association persisted after controlling for potential confounders. Disclosure - Dr. Shaheen receives research funding from GI Solutions, a subsidiary of Covidien. This research was supported by an industry grant from This research was funded by GI Solutions, a subsidiary of Covidien.