Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett's Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment

Figure 2. The irregularly-shaped resected specimen Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett’s Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment Cary C. Cotton*, W. Asher Wolf, Nan Li, Sarina Pasricha, Kelly E. Hathorn, Melissa Spacek, Susan E. Moist, Ryan D. Madanick, Evan S. Dellon, Nicholas J. Shaheen Center for Esophageal Diseases & Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC Background: Radiofrequency ablation (RFA) is a safe and effective treatment for Barrett’s esophagus (BE). The development of erosive esophagitis (EE) during treatment represents incomplete control of reflux, and may retard reversion to squamous www.giejournal.org Vol epithelium. Methods: We conducted a retrospective study of patients who underwent RFA for dysplastic BE at University of North Carolina Hospitals between March 16, 2006 and August 30, 2013. Patients were excluded for non-dysplastic BE and invasive esophageal adenocarcinoma. We used nonparametric statistics to analyze the impact of EE at the first endoscopy or development of EE during or after ablation on outcomes of RFA. We assessed 3 types of EE: 1) Prevalent EE was defined as EE of any grade at the initial endoscopy in a patient scheduled for RFA, 2) Incident treatment EE was defined as EE on any treatment endoscopy after the first treatment (but before attainment of complete eradication of intestinal metaplasia (CEIM)), and 3) Incident surveillance EE was defined as an initial occurrence of EE after CEIM had been attained, during routine endoscopic surveillance. Outcomes included the number of treatment endoscopies (defined as endoscopies where RFA or endoscopic mucosal resection was performed), the rate of CEIM, and the rate of IM recurrence. Risk factors for the three types of EE were identified. Statistical analysis was performed using SAS software (version 9.3.) Results: Of 302 patients, 283 met inclusion criteria. Of these, 15 patients had prevalent EE, 21 had incident treatment EE, and 17 had incident surveillance EE. Of 55 patients who had EE after the first endoscopy, 12 of these also had prevalent EE. Thus, 26 patients of 268 (9.7%) at risk developed EE during treatment and 17 patients of 201 (8.5%) who entered surveillance without prior EE developed EE during surveillance. Patients with prevalent EE received significantly more treatments (Figure; mean 4.0 vs. 3.0, p Z 0.045.) This association was also found with incident treatment EE (mean 4.0 vs. 2.9, p Z 0.005). Similar associations persisted in linear regression analysis with adjustment for segment length. Neither prevalent EE nor incident treatment EE was significantly associated with failure to reach CEIM. None of the 3 types of EE were significantly associated with intestinal metaplasia (IM) recurrence. Risk factors for prevalent EE or incident treatment EE included BE length, hiatal hernia and tobacco (table). Conclusion: Both prevalent EE at the time of baseline endoscopy as well as the development of EE during treatment are associated with an increased number of treatments necessary for successful reversion to squamous epithelium. Risk factors for prevalent EE and EE during RFA treatment include known risk factors for GERD. Control of GERD may predict the effort necessary to achieve successful reversion to squamous tissue in RFA. Risk Factors for Erosive Esophagitis by Phase of Treatment ume 79, N Prevalent Erosive Esophagitis (n [15) o. 5S : 2014 Incident Treatment Erosive Esophagitis (n[21) GASTROINTEST Incident Surveillance Erosive Esophagitis (n [17) INAL ENDOSCOPY All Patients (n[284) Mean / Percent Mean / Percent Mean / Percent Mean / Percent Age (years) 64.2 (N.S.) 64.1 (N.S.) 64.4 (N.S.) 67.9 BMI (kg/m2) 30.8 (N.S.) 30.7 (N.S.) 33.1 (pZ0.046) 29.7 Treatments (#) 4.0 (pZ0.045) 4.1 (pZ0.005) 2.6 (N.S.) 3.0 Prague M (cm) 5.4 (N.S.) 5.9 (pZ0.002) 3.9 (N.S.) 4.5