Radiofrequency ablation for long- and ultralong-segment Barrett's esophagus: A comparative long-term follow-up study

Background: The safety, efficacy, and durability of radiofrequency ablation (RFA), with or without EMR, have been established for long-segment Barrett's esophagus (LSBE). Ablating ultralong-segment Barrett's esophagus (ULSBE) may be associated with increased stricture formation, eradication failure, and treatment session requirements. Objectives: Our primary objective was to compare eradication and stricture rates between LSBE (≥3 to <8 cm) and ULSBE (≥8 cm). Our secondary objective was to evaluate treatment durability and session requirements. Design: Retrospective review of prospectively collected data. Setting: Tertiary care facility. Patients: A total of 72 patients (34 ULSBE, 38 LSBE; mean Barrett's segment length of 10.8 and 4.7 cm) underwent RFA between August 2005 and September 2010. Mean follow-up was 45 and 34 months, respectively. Main Outcome Measurements: Eradication and complication rates for ULSBE and LSBE. Results: Eradication rates for dysplasia (90% vs 88%, P = 1.0) and intestinal metaplasia (IM) (77% vs 82%, P =.77) were similar. ULSBE patients required more overall (P <.01) and circumferential (P <.01) RFA; however, stricture rates were identical (14%). There was no dysplasia recurrence, and IM recurrence was similar (ULSBE, 23%; LSBE, 16%; P =.52). At 3 years, IM remained eradicated in 65% of ULSBE and 82% of LSBE, without maintenance RFA. On multivariate regression analysis, increasing Barrett's length was associated with a reduced likelihood for eradicating IM (odds ratio 0.87; 95% CI, 0.75-1.00), but not dysplasia (odds ratio 1.13; 95% CI, 0.95-1.35). Limitations: Single center. Conclusion: ULSBE can be treated in its entirety at each session with efficacy and safety comparable to LSBE. ULSBE requires more effort to achieve IM eradication, and RFA is less durable in maintaining this eradication at 3-year follow-up.