Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus

W. Asher Wolf, Sarina Pasricha, Cary Cotton, Nan Li, George Triadafilopoulos, V. Raman Muthusamy, Gary W. Chmielewski, F. Scott Corbett, Daniel S. Camara, Charles J. Lightdale, Herbert Wolfsen, Kenneth J. Chang, Bergein F. Overholt, Ronald Pruitt, Atilla Ertan, Srinadh Komanduri, Anthony Infantolino, Richard I. Rothstein, Nicholas J. Shaheen

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    Abstract

    Background & Aims Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality. Methods We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality. Results Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA. Conclusions Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

    Original languageEnglish (US)
    Pages (from-to)1752-1761.e1
    JournalGastroenterology
    Volume149
    Issue number7
    DOIs
    StatePublished - Dec 1 2015

    Fingerprint

    Barrett Esophagus
    Adenocarcinoma
    Mortality
    Incidence
    Logistic Models
    Registries
    Histology
    Odds Ratio

    All Science Journal Classification (ASJC) codes

    • Hepatology
    • Gastroenterology

    Cite this

    Wolf, W. A., Pasricha, S., Cotton, C., Li, N., Triadafilopoulos, G., Muthusamy, V. R., ... Shaheen, N. J. (2015). Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. Gastroenterology, 149(7), 1752-1761.e1. https://doi.org/10.1053/j.gastro.2015.08.048

    Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. / Wolf, W. Asher; Pasricha, Sarina; Cotton, Cary; Li, Nan; Triadafilopoulos, George; Muthusamy, V. Raman; Chmielewski, Gary W.; Corbett, F. Scott; Camara, Daniel S.; Lightdale, Charles J.; Wolfsen, Herbert; Chang, Kenneth J.; Overholt, Bergein F.; Pruitt, Ronald; Ertan, Atilla; Komanduri, Srinadh; Infantolino, Anthony; Rothstein, Richard I.; Shaheen, Nicholas J.

    In: Gastroenterology, Vol. 149, No. 7, 01.12.2015, p. 1752-1761.e1.

    Research output: Contribution to journalArticle

    Wolf, WA, Pasricha, S, Cotton, C, Li, N, Triadafilopoulos, G, Muthusamy, VR, Chmielewski, GW, Corbett, FS, Camara, DS, Lightdale, CJ, Wolfsen, H, Chang, KJ, Overholt, BF, Pruitt, R, Ertan, A, Komanduri, S, Infantolino, A, Rothstein, RI & Shaheen, NJ 2015, 'Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus', Gastroenterology, vol. 149, no. 7, pp. 1752-1761.e1. https://doi.org/10.1053/j.gastro.2015.08.048
    Wolf, W. Asher ; Pasricha, Sarina ; Cotton, Cary ; Li, Nan ; Triadafilopoulos, George ; Muthusamy, V. Raman ; Chmielewski, Gary W. ; Corbett, F. Scott ; Camara, Daniel S. ; Lightdale, Charles J. ; Wolfsen, Herbert ; Chang, Kenneth J. ; Overholt, Bergein F. ; Pruitt, Ronald ; Ertan, Atilla ; Komanduri, Srinadh ; Infantolino, Anthony ; Rothstein, Richard I. ; Shaheen, Nicholas J. / Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus. In: Gastroenterology. 2015 ; Vol. 149, No. 7. pp. 1752-1761.e1.
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    abstract = "Background & Aims Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality. Methods We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality. Results Among 4982 patients, 100 (2{\%}) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2{\%}) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3{\%}) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67{\%}) had baseline HGD, and 3 (33{\%}) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15{\%}) and extraesophageal cancers (15{\%}). No deaths were associated with RFA. Conclusions Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1{\%} died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.",
    author = "Wolf, {W. Asher} and Sarina Pasricha and Cary Cotton and Nan Li and George Triadafilopoulos and Muthusamy, {V. Raman} and Chmielewski, {Gary W.} and Corbett, {F. Scott} and Camara, {Daniel S.} and Lightdale, {Charles J.} and Herbert Wolfsen and Chang, {Kenneth J.} and Overholt, {Bergein F.} and Ronald Pruitt and Atilla Ertan and Srinadh Komanduri and Anthony Infantolino and Rothstein, {Richard I.} and Shaheen, {Nicholas J.}",
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    T1 - Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett's Esophagus

    AU - Wolf, W. Asher

    AU - Pasricha, Sarina

    AU - Cotton, Cary

    AU - Li, Nan

    AU - Triadafilopoulos, George

    AU - Muthusamy, V. Raman

    AU - Chmielewski, Gary W.

    AU - Corbett, F. Scott

    AU - Camara, Daniel S.

    AU - Lightdale, Charles J.

    AU - Wolfsen, Herbert

    AU - Chang, Kenneth J.

    AU - Overholt, Bergein F.

    AU - Pruitt, Ronald

    AU - Ertan, Atilla

    AU - Komanduri, Srinadh

    AU - Infantolino, Anthony

    AU - Rothstein, Richard I.

    AU - Shaheen, Nicholas J.

    PY - 2015/12/1

    Y1 - 2015/12/1

    N2 - Background & Aims Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality. Methods We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality. Results Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA. Conclusions Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

    AB - Background & Aims Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality. Methods We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality. Results Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA. Conclusions Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.

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