Development and External Validation of a Model to Predict Complex Treatment After Radiofrequency Ablation 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 <50% squamous conversion after RFA 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 (AUC 0.84).CONCLUSIONS: We developed a prognostic model that identified patients with BE length ≥9cm and HGD/EAC 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 (NTR NL7039).