Our study cohort consisted of all patients treated with RFA for BE who underwent subsequent selleck screening library biopsy.
SSIM was defined as metaplastic columnar tissue found beneath an overlying layer of intact squamous epithelium. We performed a simple bivariate analysis comparing those with and those without SSIM using parametric statistics. We then performed logistic regression analysis including predictor variables associated with SSIM in bivariate analysis (p<0.2). The model was reduced using the likelihood ratio test to determine any independent predictors of SSIM (p<0.05). At least one biopsy session was performed in 4691 of 5530 (85%) patients treated with RFA for BE, among whom 410 (8.7%) were found to have SSIM on at least one occasion on follow-up endoscopic biopsies. Compared to those without subsquamous metaplasia, patients with SSIM were older (64.0 vs. 61.6 years, p<0.0001); more commonly male (79 vs. 73%, p=0.02); had longer BE segments (5.3 vs. 3.9 cm, p<0.0001); more
frequently 3Methyladenine had advanced neoplasia (high-grade dysplasia, intramucosal carcinoma, invasive cancer) before treatment (35% vs 23%, p<0.001); required more RFA treatment sessions (2.7 vs. 2.3, p<0.0001); and had more biopsy sessions performed (1.7 vs. 1.3, p<0.0001). In our multivariable logistic regression model, SSIM was independently associated with: 1) increased age (OR 1.02 per year, 95% CI 1.01 - 1.03); 2) length of Barrett's (1.08 per cm, 1.05 - 1.11); 3) number of RFA treatment sessions (1.11 per session, 1.05 - 1.17); 4) PPI compliance during treatment (1.47, 1.10 - 1.96); and 5) number of biopsy sessions (1.19 per session; 1.13 - 1.26). Of subjects treated with RFA for BE in a national registry, 8.7% were found to have SSIM at some point on follow-up biopsies. SSIM was independently associated with age, BE length, number of RFA treatment sessions, PPI compliance, and number of biopsy sessions performed. Surveillance biopsies of endoscopically normal mucosa are warranted after RFA, particularly among patients with these risk factors. Novel approaches
to identify sub-squamous disease may have mafosfamide utility in surveillance of the post-ablation patients, particularly those at high risk for SSIM. Subsquamous metaplasia (n=410) No subsquamous metaplasia (n=4281) p-value Age, yrs 64.0 ± 10.9 61.6 ± 11.3 <0.0001 Caucasian race, % (n) 92% (378) 93% (3996) 0.38 Male gender, % (n) 79% (322) 73% (3137) 0.02 Length of BE segment, cm 5.3 ± 3.7 3.9 ± 3.2 <0.0001 Pre-treatment fundoplication, % (n) 8% (31) 5% (228) 0.058 Advanced neoplasia before treatment (HGD, IMC, EAC), % (n) 35% (142) 24% (1044) <0.001 Treated with EMR before RFA, % (n) 10% (41) 10% (412) 0.81 Total RFA treatments 2.7 ± 1.4 2.3 ± 1.2 <0.0001 Circumferential treatments 0.9 ± 0.8 0.6 ± 0.8 Focal treatments 1.7 ± 1.6 1.3 ± 1.2 Total biopsies performed 1.7 ± 1.6 1.3 ± 1.2 <0.0001 Treatment at an academic medical center, % (n) 33% (134) 29% (1254) 0.