Barrett’s esophagus afte RF ablation vs. cryoballoon ablation - Rate of Recurrence

The study compared the long-term recurrence rates of Barrett's esophagus (BE) in patients who achieved complete remission of intestinal metaplasia (CRIM) after undergoing treatment with either radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Below is a detailed breakdown of the recurrence rates and key findings:

Overall Recurrence of Barrett's Esophagus

• Initial Analysis: RFA appeared to have a higher risk of "any BE recurrence" compared to CBA. However, this difference disappeared when minimal recurrence at the gastroesophageal junction was excluded and when patient characteristics were balanced using propensity-score matching.
• Final Conclusion: After accounting for these factors, the recurrence rates of Barrett’s esophagus were found to be comparable between RFA and CBA. Both treatments demonstrated similar long-term durability in preventing recurrence.

Dysplastic Recurrence Rates

• Dysplastic recurrence refers to the return of abnormal or precancerous changes in the esophageal tissue, which is a more concerning outcome than non-dysplastic recurrence.
• The rates of dysplastic recurrence were similar between the two groups in all analyses:
• Cryoballoon ablation (CBA): 3.7 per 100 patient-years
• Radiofrequency ablation (RFA): 2.8 per 100 patient-years
• The recurrence curves for dysplasia were nearly overlapping between the two groups, indicating no significant difference in the risk of dysplastic recurrence.

Key Predictor of Recurrence

• The baseline length of the Barrett’s segment was identified as a significant predictor of recurrence. Patients with longer BE segments at the start of treatment were more likely to experience both:
• Any recurrence of BE
• Dysplastic recurrence
• This finding was consistent regardless of whether the patient received RFA or CBA.

Conclusion

Both RFA and CBA are effective and durable options for treating Barrett's esophagus and preventing its recurrence after achieving CRIM. The long-term rates of both any recurrence and dysplastic recurrence are comparable between the two modalities. The choice of treatment may depend on other factors, such as patient-specific characteristics, physician expertise, and resource availability, rather than significant differences in recurrence rates.