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HALO360+ Ablation Catheter Image courtesy of Covidien/BâRRX Medical
By Ted Bosworth

San Diego—Radiofrequency ablation (RFA) has become the dominant therapy for treating dysplasia related to Barrett’s esophagus (BE), a disease that becomes more prevalent with age. Although RFA is known to be effective and reasonably safe overall, it has only recently been studied as a treatment for older patients.

“Younger patients appear to achieve higher rates of complete eradication of intestinal metaplasia and to do so in a shorter time frame, but older subjects appear to tolerate RFA as well as younger subjects,” said Milli Gupta, MD, Mayo Clinic, Rochester, Minn., one of the authors of a study comparing the efficacy and safety of RFA in older versus younger patients. Dr. Gupta, who conducted the study with senior author, Prasad G. Iyer, MD, also at Mayo Clinic, noted that the rates of recurrence did not appear to be accelerated in older patients and that the data do not support different patterns of surveillance for BE after RFA, based on age. Dr. Gupta provided the results of this multicenter retrospective study at the 2012 Digestive Disease Week (DDW) meeting.

The study included 529 patients treated with RFA over an eight-year period at three participating centers involved in BE research. Eighty-three percent of patients were younger than age 75 years and 17% were older than age 75 years. The mean follow-up after RFA was approximately two years for both groups. There were no significant differences in baseline characteristics, such as length of BE in centimeters and presence of diaphragmatic hernia. The exception was a greater proportion of older patients had high-grade dysplasia (38% vs. 32%; P<0.0068).

The difference in the mean time to complete eradication of intestinal metaplasia (1.21 vs. 1.37 years; P<0.0033) and the proportion who achieved this eradication (44% vs. 27%; P<0.0034) favored younger patients, but none of the complications, including bleeding (0.68% vs. 0%) hospitalization (0.68% vs. 0%) or esophageal tears (0.22% vs. 1.1%) were statistically significant when the groups were compared.

These data are useful because they encourage the use of RFA even in older individuals, who may have more complications if their lesions progress to cancer, said Julian Abrams, MD, MPH, assistant professor of medicine, Columbia College of Physicians and Surgeons, New York City.

“The average age of [patients with] esophageal cancer is over 70 years of age and older patients are frequently poor candidates for surgical resection. As such, we often end up performing endoscopic therapy for Barrett’s esophagus with high-grade dysplasia or intramucosal carcinoma in older patients,” said Dr. Abrams, who was not involved in the study. “It is therefore very reassuring to see that RFA has a comparable safety profile in an older population compared with younger patients.”