Development and External Validation of a Model to Predict Complex Treatment After Radiofrequency Ablation for Barrett's Esophagus With Early Neoplasia

Sanne N. van Munster, Esther Nieuwenhuis, Raf Bisschops, Hilde Willekens, Bas L.A.M. Weusten, Lorenza Alvarez Herrero, Auke Bogte, Alaa Alkhalaf, Ed B.E. Schenk, Erik J. Schoon, Wouter Curvers, Arjun D. Koch, Pieter Jan F. de Jonge, Tjon J. Tang, Wouter B. Nagengast, Jessie Westerhof, Martin H.M.G. Houben, Jacques J.G.H.M. Bergman*, Roos E. Pouw

*Corresponding author for this work

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Abstract

Background & Aims: Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is safe and leads to complete eradication in the majority of patients. However, a subgroup will experience a more complex treatment course with a risk for failure or disease progression. Early identification of these patients may improve patient counseling and treatment outcomes. We aimed to develop a prognostic model for a complex treatment course. Methods: We collected data from a nationwide registry that captures outcomes for all patients undergoing endoscopic eradication therapy for early BE neoplasia. A complex treatment course was defined as neoplastic progression, treatment failure, or the need for endoscopic resection during the radiofrequency ablation treatment phase. We developed a prognostic model using logistic regression. We externally validated our model in an independent registry. Results: A total of 1386 patients were included, of whom 78 (6%) had a complex treatment course. Our model identified patients with a BE length of 9 cm or longer with a visible lesion containing high-grade dysplasia/cancer, and patients with less than 50% squamous conversion after radiofrequency ablation were identified as high risk for a complex treatment. This applied to 8% of the study population and included 93% of all treatment failures and 76% of all patients with advanced neoplastic progression. The model appeared robust in multiple sensitivity analyses and performed well in external validation (area under the curve, 0.84). Conclusions: We developed a prognostic model that identified patients with a BE length of 9 cm or longer and high-grade dysplasia/esophageal adenocarcinoma and those with poor squamous regeneration as high risk for a complex treatment course. The good performance in external validation suggests that it may be used in clinical management (Netherlands Trial Register: NL7039).

Original languageEnglish
Pages (from-to)2495-2504.e5
JournalClinical Gastroenterology and Hepatology
Volume20
Issue number11
DOIs
Publication statusPublished - 1 Nov 2022

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