Su1467 Compliance With High-Dose Acid Suppression Does Not Appreciably Alter the Efficacy or Safety of Radiofrequency Ablation (RFA) in Barrett's Esophagus (BE): Results From the U.S. RFA Registry

Compliance With High-Dose Acid Suppression Does Not Appreciably Alter the Efficacy or Safety of Radiofrequency Ablation (RFA) in Barrett’s Esophagus (BE): Results From the U.S. RFA Registry Ryan D. Madanick*, William J. Bulsiewicz, Herbert C. Wolfsen, Charles J. Lightdale, William D. Lyday, George Triadafilopoulos, Evan S. Dellon, Richard I. Rothstein, Nicholas J. Shaheen University of North Carolina School of Medicine, Chapel Hill, NC; Mayo Clinic Florida, Jacksonville, FL; Columbia University School of Medicine, New York, NY; Atlanta Gastroenterology Associates, Atlanta, GA; Stanford University School of Medicine, Palo Alto, CA; Dartmouth University School of Medicine, Hanover, NH Background/Aim: Radiofrequency ablation (RFA) for Barrett’s esophagus (BE) requires adequate esophageal acid control to permit the growth of neosquamous epithelium. Currently patients are placed on high-doses of PPI (twice daily) during and after RFA treatment. However the effect of nonadherence to this regimen is unknown. The aim of this study was to assess the relationship between adherence to PPI and the efficacy and safety of RFA in BE in a nationwide registry. Methods: The U.S. RFA Registry is a prospective study of patients with BE treated with RFA at 148 institutions. Information collected includes demographic data, histology prior to treatment, endoscopic findings, date and number of treatment sessions, ablation outcomes, and complications. Self-reported PPI compliance with a regimen of twice daily PPI was assessed at each visit before therapy was given. Analysis was performed comparing those compliant at all visits to those partially or non-compliant. Our safety cohort consisted of all patients treated with RFA, while our efficacy cohort was restricted to subjects who had a biopsy performed 12 months or more after initial treatment. We compared safety and efficacy outcomes among those who were PPI compliant versus those partially/non-compliant using parametric tests for statistical comparisons. Safety outcomes included rates of stricture, GI bleeding, and hospitalization. Efficacy outcomes included complete eradication of intestinal metaplasia (CEIM), complete eradication of dysplasia (CED), and the number of treatment sessions to CEIM. Results: Among 5530 treated with RFA, 4580 (82%) were PPI compliant at all visits while 950 (17%) were partially (n 930) or noncompliant (n 20). There were no deaths. Rates of stricture (2.4% if compliant, 3.0% if partially or non-compliant), GI bleeding (0.4% if compliant, 0.5% if partially or non-compliant), and hospitalization (1.7% if compliant, 1.7% if partially or non-compliant) were similar regardless of PPI adherence (p 0.05). 2936 patients (53%) had a biopsy performed 12 months or more after treatment and were included in the efficacy analysis, including 2546 (81%) who were PPI compliant and 590 (19%) who were partially or non-compliant. The rates of CED (90%) were similar regardless of PPI adherence, however there was a trend toward higher rates of CEIM if PPI compliant (75% vs 71%, p 0.06). The mean number of treatments necessary to achieve CEIM was greater in patients who were PPI compliant (2.8) compared to those partially or non-compliant (2.6) (p 0.03). Conclusions: In a large, nationwide registry, most patients were compliant with a high dose (twice daily) PPI regimen. Among the over 700 patients who were not fully compliant, poor adherence to a high dose acid suppression regimen did not significantly alter the risk of complications or the likelihood of successful eradication of BE.