NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.
The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.
"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.
However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.
To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.
The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.
The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).
The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.
The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.
Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.
Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.