Is Barrett’s Esophagus Thickness a Marker for Response to Radiofrequency Ablation Therapy?
Prateek Sharma, MD, FASGE, reviewing Levink IJM, et al. Clin Gastroenterol Hepatol 2020 May 17.
Radiofrequency ablation (RFA) is a widely used modality for treating flat Barrett’s esophagus (BE) dysplasia, with the goal of achieving complete eradication of intestinal metaplasia (CE-IM). However, some patients do not achieve CE-IM despite multiple RFA sessions. Volumetric laser endomicroscopy (VLE) is a technology that provides visualization of the superficial layers of the esophageal wall. This retrospective VLE registry-based study evaluated whether thickness of the BE epithelium was a determinant of treatment response, CE-IM, or strictures after RFA.
A total of 61 patients with a mean age of 63.5 years, median Prague classification length of C1M3, and mean BE thickness of 408.2 micrometers, who had a baseline VLE scan followed by RFA for BE, were included in the analysis. It was noted that every 100-micrometer increase in mean thickness of BE was associated with a 12% decrease (95% confidence interval, -24% to -1%) in response (reduction of Prague M length) after RFA. The mean BE thickness was lower for the CE-IM group at 394.8 micrometers (standard deviation [SD], 121.7 micrometers) than the non-CE-IM group at 428.4 micrometers (SD, 88.9 micrometers), but this was not statistically significant (P=.11). Similarly, BE thickness was also higher in the 6 patients who had strictures (483.4 micrometers; SD, 96.7 micrometers) as compared to those who did not (402.8 micrometers; SD, 105.3 micrometers; P=.065).
COMMENTA BE thickness of <400 micrometers is associated with better response to RFA. A higher rate of CE-IM and less strictures post-RFA are seen in those patients whose baseline BE epithelium is thin. If these findings are validated, baseline BE thickness could serve as an endoscopic marker for response to ablation therapy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Levink IJM, Tearney GJ, Erler NS, Wolfsen HC, Siersema PD, Wallace MB. Barrett’s epithelial thickness, assessed by volumetric laser endomicroscopy, is associated with response to radiofrequency ablation. Clin Gastroenterol Hepatol 2020 May 17. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.05.023)
