Safety, efficacy, and changing trends in endoscopic ablation for dysplastic Barrett esophagus in Poland: a long-term multicenter retrospective analysis

Endoscopic ablation is the mainstay of treatment for dysplastic Barrett esophagus (BE), of which radiofrequency ablation (RFA) and argon plasma coagulation (APC) are the most widely available options. We aimed to analyze the safety and outcomes of endoscopic ablation for BE at the Polish centers off...

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Published in:Polskie archiwum medycyny wewne̦trznej Vol. 135; no. 1
Main Authors: Romanczyk, Marcin, Klimkowski, Robert, Kukla, Michal, Pilonis, Nastazja D, Romanczyk, Tomasz, Gorecka, Magda, Lesinska, Magdalena, Wronska, Ewa, Regula, Jaroslaw, Kaminski, Michal F, Januszewicz, Wladyslaw
Format: Journal Article
Language:English
Published: Poland 30.01.2025
Subjects:
Adult
Aged
Argon Plasma Coagulation
Barrett Esophagus - surgery
Catheter Ablation
Esophagoscopy
Female
Humans
Male
Middle Aged
Poland
Radiofrequency Ablation
Retrospective Studies
Treatment Outcome
Poland
ISSN:1897-9483
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Summary:Endoscopic ablation is the mainstay of treatment for dysplastic Barrett esophagus (BE), of which radiofrequency ablation (RFA) and argon plasma coagulation (APC) are the most widely available options. We aimed to analyze the safety and outcomes of endoscopic ablation for BE at the Polish centers offering this procedure. We retrospectively analyzed data from 3 high‑volume endoscopy centers between 2002 and 2024. We included adult patients with confirmed BE who received at least 1 ablation session with either conventional / hybrid APC (APC/h‑APC) or RFA, followed by at least 1 endoscopic follow‑up. The outcomes included the rate of complete remission of intestinal metaplasia (CR‑IM) and dysplasia (CR‑D), and adverse event (AE) rate. Risk factors for treatment failure were analyzed using a multivariable logistic regression model. We analyzed data from 191 patients, of which 160 were included (mean [SD] age, 59.4 [10.8] years; 79.4% men). The overall CR‑IM and CR‑D rates were 80% and 93.8%, respectively. We reported 49 minor AEs (30.6%), and 9 major AEs (5.6%), including 7 esophageal strictures (4.4%). In the early 2000s, APC was the only available ablation modality. However, since 2008, it has been gradually replaced by RFA. Notably, RFA was used for more severe BE cases and carried a higher risk of failed treatment than APC/h‑APC (odds ratio [OR], 7.48; P = 0.001). Other risk factors for treatment failure included the BE length (OR, 1.3; P = 0.002) and diabetes (OR, 7.48; P <0.001). Endoscopic ablation for BE is safely and effectively provided in Poland at a few expert centers. Patients with diabetes and long‑segment BE are at an increased risk for treatment failure.
ISSN:1897-9483
DOI:10.20452/pamw.16912