Recurrence Rates of Barrett’s Esophagus and Dysplasia in Patients Successfully Treated with Radiofrequency Ablation vs Cryoballoon Ablation: a Comparative Study

Background and aims Endoscopic eradication therapy (EET) is recommended for the management of dysplastic Barrett's esophagus (BE) and intramucosal adenocarcinoma (IMC). Both radiofrequency (RFA) and cryoballoon ablation (CBA), can induce complete remission of Intestinal metaplasia (CRIM). We aimed to compare long-term durability following CRIM in patients treated with RFA vs. CBA. Methods We conducted a retrospective cohort study to analyze patient outcomes following EET with RFA or CBA at 2 referral centers. We measured and compared the recurrence rate of BE with or without dysplasia after CRIM, using Cox proportional hazard models and propensity score-matched analyses. Our secondary aim was to identify predictors of recurrence. Results: We included 681 patients achieving CRIM (RFA: 610 and CBA: 71). Median follow-up was 4.1 years following RFA and 4.4 years following CBA. A multivariable model revealed a higher risk of any recurrence with RFA (HR, 2.19; 95 % CI, 1.18- 4.06; P= 0.013), but not dysplastic recurrence (RFA vs. CBA: HR, 0.88; 95 % CI, 0.39- 1.97; P= 0.75). However, a comparable risk of "any recurrence" (RFA vs CBA, HR, 1.18; 95% CI, 0.61-2.30, p=0.62) was observed after excluding IM-GEJ. Propensity score-matched analysis (54 CBA and 54 RFA cases) showed that RFA and CBA groups had comparable recurrence risk. Baseline maximal BE length was associated with a higher risk of any (HR 1.07; P < 0.01) and dysplastic recurrence (HR 1.11; P = 0.001). Conclusions: The rates of any and dysplastic BE recurrence were comparable with both modalities in this non-randomized study.