Patients with Barrett’s esophagus (BE)-related neoplasia had low recurrence rates after receiving endoscopic eradication therapy (EET), according to prospective study results published in Clinical Gastroenterology and Enterology.
To investigate the long-term effects of complete eradication of intestinal metaplasia (CE-IM) in patients with BE-related neoplasia and to assess current surveillance guidelines in this patient population, 807 patients (mean age, 65.2±11.4 years) were prospectively included from 4 tertiary-care referral centers in the United States between 2013 and 2018 (ClinicalTrials.gov identifier: NCT02634645). The patients had an average BE length of 3.9±2.3 cm, underwent on average 2.6±1.3 sessions in order to achieve CE-IM, and were followed for up to 5 years after CE-IM.
Recurrence of intestinal metaplasia was observed in 121 patients (15%), with an incidence rate (IR) per 100 person-years of 5.2 (95% CI, 4.4-6.2). The investigators observed dysplasia in 41 patients (5.1%) with an IR of 1.8 (95% CI, 1.3-2.4).
The rate of recurrence was not constant over time in this patient population (P <.001), but the results indicated that recurrences peaked at 1.6 years following CE-IM. The rate of recurrence was observed to differ depending on patient baseline histology. Specifically, patients with high-grade dysplasia or intramucosal cancer had an adjusted odds ratio (aOR) of 4.2 (95% CI, 1.9-9.4), while patients with reflux or hiatal hernia had higher rates with an aOR of 12.1 (95% CI, 4.3-34.1) and 13.8 (95% CI, 3.4-56.3), respectively. The investigators did not observe an association between patient age or BE length with recurrence of intestinal metaplasia.
Study limitations include the follow-up time; it is unclear whether recurrence has plateaued at 5 years post CE-IM or if more long-term recurrences are common. Furthermore, included patients received either endoscopic mucosal resection or radiofrequency ablation; other ablation methods, such as cryotherapy, may have differing long-term outcomes.
The study investigators concluded that recurrence rates of intestinal metaplasia were low in patients with BE who underwent EET and assert that as recurrence peaked between 1 to 2 years after CE-IM, surveillance with endoscopy may be unnecessary more than 1 year after CE-IM.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Wani S, Han S, Kushnir V, et al. Recurrence is rare following complete eradication of intestinal metaplasia in patients with Barrett’s esophagus and peaks at 18 months [available online January 23, 2020]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.01.019