Low Recurrence of Intestinal Metaplasia After Endoscopic Eradication Therapy

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Patients with Barrett’s esophagus undergoing endoscopic eradication therapy demonstrated a low rate of recurrence of intestinal metaplasia and dysplasia after complete eradication of intestinal metaplasia.

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.

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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.

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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