Recurrent GEJIM After Endoscopic Therapy for Barrett Esophagus Not Associated With Higher Risk for Dysplasia

Investigators assessed whether recurrent gastroesophageal junction intestinal metaplasia is associated with increased risk for subsequent dysplasia and whether endoscopic treatment lowers this risk if so.

Recurrent gastroesophageal junction intestinal metaplasia (GEJIM) after endoscopic eradication of Barrett esophagus was not found to be associated with an increased risk for subsequent dysplasia, according to findings from a study published in Gastrointestinal Endoscopy.

The researchers conducted a retrospective, multicenter cohort study of patients with Barrett esophagus who had complete eradication of intestinal metaplasia. Recurrent GEJIM was defined as nondysplastic intestinal metaplasia on GEJ biopsy specimens without endoscopic evidence of Barrett esophagus. Participants were classified as “never-GEJIM,” “GEJIM-observed,” or “GEJIM-treated.” The primary outcome was dysplasia recurrence; analyses were performed via log-rank tests and Cox proportional hazards modeling.

A total of 633 patients (mean age, 64 years; 85% male) were included in the analysis, conducted at a median follow-up of 47 months (interquartile range, 24-69). Most (81%) patients had high-grade dysplasia or intramucosal adenocarcinoma before treatment; dysplasia recurrence was 2.2% per year. GEJIM-observed patients had the lowest rate of recurrence (0.6%/year), followed by the GEJIM-treated group (2.2%/year) and never-GEJIM group (2.6%/year; log-rank P =.07).

Multivariate analyses showed that the risk of dysplasia recurrence was “significantly lower” in GEJIM-observed patients vs never-GEJIM patients (adjusted hazard ratio [aHR], 0.19; 95% CI, 0.05-0.81). This risk was not different in GEJIM-treated patients (aHR, 0.81; 95% CI, 0.39-1.67). Older age and longer initial Barrett esophagus length were independently associated with recurrence, according to the investigators.

“In this multicenter retrospective cohort study of [patients with] Barrett esophagus who were treated with endoscopic eradication therapy and achieved complete eradication of intestinal metaplasia, the recurrence of nondysplastic intestinal metaplasia at the gastroesophageal junction was not associated with increased risk of subsequent gastroesophageal junction dysplasia as compared with patients who never developed recurrent GEJIM,” the study authors stated. “In fact, patients who had recurrent GEJIM that was observed had the lowest risk of progression to dysplasia. Furthermore, treatment of recurrent GEJIM was not associated with a further reduction in the risk of progression to dysplasia.”

Study limitations included the absence of protocolized treatment and sampling and the nonrandomized treatment assignment for recurrent GEJIM. In addition, the available data did not allow for a clear assessment of the relationships between specific treatment modalities and dysplasia recurrence.

“After successful endoscopic therapy of [Barrett esophagus], recurrent GEJIM is a not uncommon finding and may be associated with a low risk of subsequent dysplasia,” the researchers concluded. “As this was a retrospective study, additional prospective randomized studies will be important in determining whether observation may be appropriate for these patients.”

Disclosures: Some of the study authors reported affiliations with pharmaceutical and medical device companies. Please see the original reference for a full list of the authors’ disclosures.

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Solfisburg QS, Sami SS, Gabre J, et al. Clinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett’s esophagus.Gastrointest Endosc. Published online October 31, 2020. doi: 10.1016/j.gie.2020.10.027