Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett's esophagus

• Published in: Gastrointestinal endoscopy Vol. 80; no. 1; pp. 71 - 77
• Main Authors: Fudman, David I., MD, Lightdale, Charles J., MD, Poneros, John M., MD, Ginsberg, Gregory G., MD, Falk, Gary W., MD, MS, Demarshall, Maureen, RN, Gupta, Milli, MD, Iyer, Prasad G., MD, MS, Lutzke, Lori, RN, CCRP, Wang, Kenneth K., MD, Abrams, Julian A., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2014
• Subjects: Adult; Aged; Aged, 80 and over; Barrett Esophagus - surgery; Catheter Ablation - methods; Esophagoscopy - methods; Female; Gastroenterology and Hepatology; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; BE; esophageal adenocarcinoma; EAC; Barrett's esophagus; complete remission of intestinal metaplasia; CRIM; RFA; radiofrequency ablation
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.01.007

Background Radiofrequency ablation (RFA) has become an accepted form of endoscopic treatment for Barrett's esophagus (BE), yet reported response rates are variable. There are no accepted quality measures for performing RFA, and provider-level characteristics may influence RFA outcomes. Objective To determine whether endoscopist RFA volume is associated with rates of complete remission of intestinal metaplasia (CRIM) after RFA in patients with BE. Design Retrospective analysis of longitudinal data. Setting Three tertiary-care medical centers. Patients Patients with BE treated with RFA. Intervention RFA. Main Outcome Measurements For each endoscopist, we recorded RFA volume, defined as the number of unique patients treated as well as corresponding CRIM rates. We calculated a Spearman correlation coefficient relating these 2 measures. Results We identified 417 patients with BE treated with RFA who had at least 1 post-RFA endoscopy with biopsies. A total of 73% of the cases had pretreatment histology of high-grade dysplasia or adenocarcinoma. The procedures were performed by 7 endoscopists, who had a median RFA volume of 62 patients (range 20-188). The overall CRIM rate was 75.3% (provider range 62%-88%). The correlation between endoscopist RFA volume and CRIM rate was strong and significant (rho = 0.85; P  = .014). In multivariable analysis, higher RFA volume was significantly associated with CRIM ( P for trend .04). Limitations Referral setting may limit generalizability. Limited number of endoscopists analyzed. Conclusion Endoscopist RFA volume correlates with rates of successful BE eradication. Further studies are required to confirm these findings and to determine whether RFA volume is a valid predictor of treatment outcomes in BE.