Development and external validation of a model to predict complex treatment after RFA for Barrett's esophagus with early neoplasia

BACKGROUND AND AIMS: Endoscopic eradication therapy (EET) 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 such complex treatment course. METHODS: We collected data from a nationwide registry that captures outcomes for all patients undergoing EET for early BE neoplasia. A complex treatment course was defined as neoplastic progression, treatment failure, or need for endoscopic resection during RFA treatment phase. We developed a prognostic model using logistic regression. We externally validated our model in an independent registry. RESULTS: A total of 1,356 patients were included of which 78 (6%) had complex treatment course. Our model identified patients with BE length ≥9cm with a visible lesion containing HGD/cancer; and patients with