Su1118 APPEARANCE OR PROGRESSION OF DYSPLASIA AND CANCER IN BARRETT’S ESOPHAGUS UNDERGOING RADIOFREQUENCY ABLATION

Abstract

Barrett’s esophagus (BE) is a known risk factor for esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) has been associated with a high rate of complete eradication for dysplasia and intestinal metaplasia. Data are limited on patients who have progression of dysplasia or development of EAC while undergoing RFA therapy. We aimed to better characterize these patients. This was a retrospective review of medical records at a tertiary academic medical center. We included patients with at least one RFA treatment for BE without EAC. Patients achieving complete eradication of dysplasia were excluded. Data collected included demographics, date of BE diagnosis, endoscopy findings, anatomic pathology, location of the newly developed dysplasia, length of BE, RFA adjuvant therapies, and date of death. A total of 475 patients underwent RFA, of which 39 (8.2%) progressed to low grade dysplasia (LGD), high grade dysplasia (HGD) or EAC while undergoing therapy. The distribution of these changes is depicted in Table 1. Only 1 patient was female. Patient demographic data is found in Table 2. For those with HGD receiving RFA, 12.6% progressed into cancer. The majority of cancer developed in the distal esophagus (13/23 = 56.5 %). Seven patients (30.4 %) had their original HGD distributed over the entire BE segment prior to initial RFA. The progression was observed after an average of 3.0 RFA sessions. Twenty patients had endoscopic mucosal resection (EMR) and 2 had esophagectomy. Four (17.4 %) patients died. Eight patients achieved complete remission of intestinal metaplasia. For those who underwent RFA for LGD, 6 patients progressed to cancer and 6 to HGD. The rate of progression into cancer was significantly lower (5.1%) than those undergoing treatment for HGD (12.6%) (p= 0.04). The average number of RFA sessions before progression was 2.6. All 6 developed cancer in the distal BE segment and 5 of these patients had original low grade dysplasia in the distal BE segment. All 6 patients received adjuvant EMR and 2 esophagectomy. Two of these patients died. The 2 patients with short segment BE (2cm and 2.75 cm) progressed to cancer. Of the 4 patients with non-dysplastic Barrett’s who progressed while receiving RFA, the dysplasia appeared in the distal BE segment in 2, in the proximal in 1 and in the mid distal in 1. One patient developed cancer, but ultimately achieved complete remission of intestinal metaplasia. Our study shows that 8.2% of patients receiving RFA for BE have progression of dysplasia or development of cancer. Those at highest risk for progression are patients initially treated for HGD with 12.6% progressing to cancer after an average of 3.0 RFA sessions. Further studies are needed to determine why this progression occurred and how it can be avoided.Tabled 1Table 1. Number of patients with progression of dysplasia or progression to cancer based on initial indication for RFA therapy.Progression to:RFA for NDBE/ID (175)RFA for LGD (117)RFA for HGD (183)Indefinite DysplasiaLow grade Dysplasia1High Grade Dysplasia26Cancer16*23*Total4 (2.3%)12 (10.3%)23 (12.6%)Abbreviations: non-dysplastic Barrett’s esophagus (NDBE), indefinite dysplasia (ID), low grade dysplasia (LGD), high grade dysplasia (HGD). *P = 0.04 for progression into cancer between LGD and HGD groups Open table in a new tab Tabled 1Table 2. Characteristics of patients who had progression of dysplasia or development of cancer after RFA.RFA for NDBE/IDRFA for LGDRFA for HGDMean Age First Dysplasia or Mean Age First BE for NDBE (Range)64.5 (60-74)68.5 (54-78)72.3 (52-84)Mean Age Diagnosis Highest Progression (Range)68.5 (61-76)71.6 (57-81)74.2 (52-82)Mean Length BE Segment cm (Range)3.8 (2-5)7.0 (2-17)7.0 (1-14)Mean Number RFA Sessions Before Progression (Range)2.0 (1-3)2.6 (1-5)3.0 (1-11)Original Site of Dysplasia in Barrett’s Segment Before RFANAProximal11Proximal Mid10Mid04Mid Distal11Distal67Entire27Unknown13Site of Progression In EsophagusProximal124Proximal Mid003Mid023Mid Distal110Distal2713Adjuvant TherapyEMR2720ESD001Chemo-radiation002Brachytherapy002Esophagectomy022Cryotherapy123Radiation001Rate of CRIM128Deaths114Abbreviations: non-dysplastic Barrett’s esophagus (NDBE), indefinite dysplasia (ID), low grade dysplasia (LGD), high grade dysplasia (HGD), not applicable (NA), complete remission of intestinal metaplasia (CRIM). Open table in a new tab