Recurrent intestinal metaplasia after radiofrequency ablation for Barrett’s esophagus: endoscopic findings and anatomic location

Radiofrequency ablation (RFA) is a safe and effective treatment for Barrett’s esophagus (BE) that results in high rates of complete eradication of intestinal metaplasia (CEIM). However, recurrence is common after CEIM and surveillance endoscopy is recommended. Neither the anatomic location nor the endoscopic appearance of these recurrences is well described

Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia

Endoscopic mucosal resection (EMR) is commonly performed before radiofrequency ablation (RFA) for nodular dysplastic Barrett’s esophagus (BE)

Single- and Multiple-Dose Pharmacokinetics of Darunavir Plus Ritonavir and Etravirine in Semen and Rectal Tissue of HIV-Negative Men

Antiretroviral therapy (ART) has become a central component of combination HIV prevention efforts. Defining the individual exposure of commercially available ART in genital secretions and vulnerable mucosal tissues is paramount to designing future prevention interventions

Intestinal Metaplasia Recurs Infrequently in Patients Successfully Treated for Barrett's Esophagus With Radiofrequency Ablation

Radiofrequency ablation (RFA) of Barrett’s esophagus (BE) is safe and effective in eradicating dysplasia and intestinal metaplasia and may reduce rates of esophageal adenocarcinoma (EAC). We assessed rates of and risk factors for disease recurrence after successful treatment of BE with RFA

Safety and Efficacy of Endoscopic Mucosal Therapy With Radiofrequency Ablation for Patients With Neoplastic Barrett's Esophagus

The goal of radiofrequency ablation (RFA) for patients with Barrett’s esophagus (BE) is to eliminate dysplasia and metaplasia. The efficacy and safety of RFA for patients with BE and neoplasia are incompletely characterized

Safety and Efficacy of Endoscopic Mucosal Therapy With Radiofrequency Ablation for Patients With Neoplastic Barrett's Esophagus

BACKGROUND& AIMS: The goal of radiofrequency ablation (RFA) for patients with Barrett’s esophagus (BE) is to eliminate dysplasia and metaplasia. The efficacy and safety of RFA for patients with BE and neoplasia are incompletely characterized. METHODS: We performed a retrospective study of 244 patients treated with RFA for BE with dysplasia or intramucosal carcinoma. Efficacy outcomes were complete eradication of intestinal metaplasia (CEIM), complete eradication of dysplasia (CED), total treatments, and RFA sessions. Safety outcomes included death, perforation, stricture, bleeding, and hospitalization. We identified factors associated with incomplete EIM and stricture formation. RESULTS: CEIM was achieved in 80% of the patients, and CED in 87%; disease progressed in 4 patients. A higher percentage of patients with incomplete EIM were female (40%) than those with CEIM (20%, P=.045); patients with incomplete EIM also had a longer segment of BE (5.5 vs 4.0 cm, P=.03), incomplete healing between treatment sessions (45% vs 15%, P=0.004), and underwent more treatment sessions (4 vs 3, P=.007). Incomplete healing was independently associated with incomplete EIM. Twenty-three patients (9.4%) had a treatment-related complication during 777 treatment sessions (3.0%), including strictures (8.2%), post-procedural hemorrhages (1.6%), and hospitalizations (1.6%). Patients that developed strictures were more likely to use non-steroidal anti-inflammatory drugs (NSAID) than those without strictures (70% vs 45%, P=.04), have undergone antireflux surgery (15% vs 3%, P=.04), or had erosive esophagitis (35% vs 12%, P=.01). CONCLUSIONS: RFA is highly effective and safe for treatment of BE with dysplasia or early-stage cancer. Strictures were the most common complications. Incomplete healing between treatment sessions was associated with incomplete EIM. NSAID use, prior anti-reflux surgery, and a history of erosive esophagitis predicted stricture formation

Intestinal Metaplasia Recurs Infrequently in Patients Successfully Treated for Barrettʼs Esophagus With Radiofrequency Ablation

OBJECTIVES: Radiofrequency ablation (RFA) of Barrett’s esophagus (BE) is safe and effective in eradicating dysplasia and intestinal metaplasia and may reduce rates of esophageal adenocarcinoma (EAC). We assessed rates of and risk factors for disease recurrence after successful treatment of BE with RFA. METHODS: We performed a retrospective cohort study of patients who completed RFA for dysplastic BE or intramucosal carcinoma (IMC), achieved complete eradication of dysplasia (CE-D) or intestinal metaplasia (CE-IM), and underwent subsequent endoscopic surveillance at a single center. Rates of disease recurrence and progression were determined. Patients with and without recurrent disease were compared to determine risk factors for recurrence. RESULTS: 262 subjects underwent RFA during the study period. Of these, 119 and 112 patients were retained in endoscopic surveillance after CE-D and CE-IM, respectively. Median observation time was 397 days (range: 54-1668 days). Eight patients (7% of those with CE-IM) had recurrent disease after a median of 235 days (range 55-1124 days). Progression to IMC (n=1) or EAC (n=2) occurred in 3 of these 8 patients, all of whom had pre-ablation high-grade dysplasia (HGD). Five patients had recurrence of non-dysplastic BE (n=3), low-grade dysplasia (n=1), and HGD (n=1). During 155 patient-years of observation, recurrence occurred in 5.2%/year, and progression occurred in 1.9%/year. No clinical characteristics were associated with disease recurrence. CONCLUSIONS: In patients with BE and dysplasia or early cancer who achieved CE-IM, BE recurred in ~5%/year. Patient characteristics did not predict recurrence. Subjects undergoing RFA for dysplastic BE should be retained in endoscopic surveillance

Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia

BACKGROUND: Endoscopic mucosal resection (EMR) is commonly performed before radiofrequency ablation (RFA) for nodular dysplastic Barrett’s esophagus (BE). OBJECTIVE: To determine the efficacy and safety of EMR before RFA for nodular BE with advanced neoplasia (high-grade dysplasia (HGD) or intramucosal carcinoma (IMC)). DESIGN: Retrospective study. SETTING: University of North Carolina Hospitals, from 2006 to 2011. PATIENTS: 169 patients with BE with advanced neoplasia – 65 patients treated with EMR and RFA for nodular disease and 104 patients treated with RFA alone for non-nodular disease. INTERVENTIONS: Endoscopic mucosal resection, radiofrequency ablation. MAIN OUTCOME MEASUREMENTS: Efficacy (complete eradication of dysplasia, complete eradication of intestinal metaplasia, total treatment sessions, RFA treatment sessions), safety (stricture formation, bleeding, and hospitalization). RESULTS: EMR followed by RFA achieved complete eradication of dysplasia and complete eradication of intestinal metaplasia in 94.0% and 88.0%, respectively, compared with 82.7% and 77.6%, respectively in the RFA only group (p=0.06 and p=0.13, respectively). The complication rates between the two groups were similar (7.7% vs. 9.6%, p=0.79). Strictures occurred in 4.6% of patients in the EMR before RFA group compared with 7.7% of patients in the RFA only group (p=0.53). LIMITATIONS: Retrospective study at a tertiary-care referral center. CONCLUSION: In patients treated with EMR before RFA for nodular BE with HGD or IMC, no differences in efficacy and safety outcomes were observed compared with RFA alone for non-nodular BE with HGD or IMC. EMR followed by RFA is safe and effective for patients with nodular BE and advanced neoplasia

Single and Multiple Dose Pharmacokinetics of Maraviroc in Saliva, Semen, and Rectal Tissue of Healthy HIV-negative Men

Background. Antiretroviral pharmacology in seminal plasma (SP) and rectal tissue (RT) may provide insight into antiretroviral resistance and the prevention of sexual transmission of human immunodeficiency virus (HIV). Saliva may be of utility for noninvasively measuring adherence