P0481 - Radiofrequency Ablation and Cryoablation for Dysplastic Barrett's Esophagus: A Potential Cause of Esophageal Mucosal Eosinophilia

Sidra Naz, MD, MPH¹, Phillip Lum, BS², Marta Davila, MD³, Deyali Chatterjee, MD³, Jianliang Dai, PhD², George Triadafilopoulos, MD⁴, Mehnaz A. Shafi, MD^1
1University of Texas MD Anderson Cancer Center, Houston, TX; ²MD Anderson Cancer Center, Houston, TX; ³The University of Texas MD Anderson Cancer Center, Houston, TX; ⁴Stanford University School of Medicine, Houston, TX

Introduction: Esophageal mucosal eosinophilia (EME) is commonly associated with gastroesophageal reflux disease (GERD) or eosinophilic esophagitis (EoE), but it could also result from ablation-induced non-specific injury.To retrospectively review the clinical, endoscopic, and histological findings of patients who developed EME after radiofrequency ablation (RFA) therapy or cryoballoon ablation (CBA) for dysplastic Barrett's esophagus (BE).

Methods: We examined the clinical, endoscopic, and histological findings of all patients with both HGD or LGD dysplastic BE who underwent endoscopic RFA and/or CBA therapy between February 2010 and February 2024 to identify EME on post-RFA and post-CBA biopsies. Patients with preexisting EoE prior to therapy were excluded. All pathology slides were systematically reviewed for the maximum number of eosinophils per high-power field (hpf). Risk factors for EME, dysphagia, and the use of proton pump inhibitors (PPI) were reviewed. The esophageal endoscopic appearance post-ablation in these patients was evaluated for stricture(s), ulcers, exudates, or EoE-like features. We also studied the BE length before and after ablation, number of RFA or CBA treatments, time interval to the development of EME post-RFA or CBA, and any subsequent resolution of EME.

Results: 707 patients underwent RFA +/- CBA for both LGD or HGD dysplastic BE and had post-treatment biopsies. 668 patients underwent RFA alone, an additional 39 patients underwent both RFA and CBA. Fourteen (2%) of patients had EME (eosinophils > 20/hpf). All patients were White; 80% of the RFA and 75% of the RFA + cryoablation group had h/o seasonal allergies. PPI use at the time of post-treatment biopsies was 100% in the RFA and 75% in RFA + CBA group. The median duration of EME was 19.7 months. No significant difference was identified in the covariates between the RFA +/- CBA treatment groups by Fisher's exact or Wilcoxon rank sum tests. However, Kaplan-Meier (KM) curve analyses analysis of the number of treatment sessions using RFA +/- CBA showed borderline significant difference in the development of EME (log-rank test p=0.051)

Discussion: The development of new onset EME after RFA +/- CBA for dysplastic BE was seen in 2% of our cohort; 80% patients had seasonal allergies. Dysphagia was rare. EME persisted for >19 months. EME eradication rates using acid suppression and/or topical steroids were 50% in both cohorts. EME, seems distinct from EoE and is probably a consequence of RFA and CBA therapy.



Disclosures:


Sidra Naz, MD, MPH¹, Phillip Lum, BS², Marta Davila, MD³, Deyali Chatterjee, MD³, Jianliang Dai, PhD², George Triadafilopoulos, MD⁴, Mehnaz A. Shafi, MD¹. P0481 - Radiofrequency Ablation and Cryoablation for Dysplastic Barrett's Esophagus: A Potential Cause of Esophageal Mucosal Eosinophilia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.