F. Scott Corbett

Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus

BACKGROUND & AIMS Radiofrequency ablation (RFA) is commonly used to treat Barretts 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 ResearchFull Report: Clinical—Alimentary TractIncidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus

BACKGROUND & AIMS Radiofrequency ablation (RFA) is commonly used to treat Barretts 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.

Mo1108 National Practice Patterns in the Timing of Radiofrequency Ablation (RFA) for Barrett's Esophagus: Results From the U.S. RFA Registry

Background: Inflammatory bowel disease (IBD) is a chronic disorder that affects approximately 1.4 million Americans, with an annual cost of

Su1022 What Is the Histology of Subsquamous Intestinal Metaplasia (SSIM) in Patients With Prior Radiofrequency Ablation (RFA) for Treatment of Barrett's Esophagus (BE)? Results From the U.S. RFA Registry

10-18 billion. A uniform approach to patient care, such as utilization of practice guidelines, may be beneficial in reducing morbidity and improving patient outcome. Objective: The aim of this study is to determine if proposed American Gastroenterological Association (AGA) quality of care guidelines can be met at a teaching program gastroenterology clinic and to determine if adherence to guidelines results in improved patient outcome. Methods: We performed a retrospective single center study of patients with IBD. Consecutive patients were identified using pharmacy, pathology, and clinic records. 234 patients were identified as having IBD. Of the 234 patients, 126 were followed in the gastroenterology clinic and included in the analysis; the remaining patients used the VA hospital for medication only. The electronic medical record was reviewed for: adherence to the ten quality improvement measures proposed by the AGA, hospitalizations and surgeries within 3 years. Results: 126 patients with IBD were included, patient characteristics are in Table 1. The AGA guidelines were met as follows: Inflammatory Bowel Disease type (99.2%), disease location (92.8%), and disease activity (96%), screening/ cessation counseling in tobacco abusers (98.8%), use of corticosteroid sparing therapy (97.6%), administration of inpatient veno-thromboembolism prophylaxis (89.5%), Yearly Influenza Vaccination (83%), inpatient testing for Clostridium difficile (74%), hepatitis B status prior to initiation of biologic therapy (73%), assessment of bone loss related to corticosteroid therapy (69%), pneumococcus vaccine administration (65%), testing for latent TB prior to initiation of biologic therapy (65%). Overall; 91 patients (72%) met 80% of the quality care guidelines. During the study period of 3 years, 17 patients were admitted for IBD related illness, 10 for non-IBD related illness and 6 patients underwent surgery. We did not find any correlation between adherence to quality of care indications and reduction in hospitalization or surgery (Table 2). Conclusions: Proposed quality of care guidelines can be met in a majority of patients in clinical practice. Adherence to guidelines did not correlate with improved patient outcomes as measured by hospitalization or surgery. Further work is required in identifying quality care measures that correlate with improvement in patient outcomes. Table 1. Patient Characteristics

Prior Fundoplication Does not Improve Safety or Efficacy Outcomes of Radiofrequency Ablation: Results from the U.S. RFA Registry

What Is the Histology of Subsquamous Intestinal Metaplasia (SSIM) in Patients With Prior Radiofrequency Ablation (RFA) for Treatment of Barretts Esophagus (BE)? Results From the U.S. RFA Registry Kelly E. Hathorn, William J. Bulsiewicz, Ronald E. Pruitt, Gary W. Chmielewski, Ryan D. Madanick, F Scott Corbett, Richard I. Rothstein, Charles J. Lightdale, George Triadafilopoulos, Nicholas J. Shaheen