Introduction: EET is endorsed by guidelines for treatment of BE-related neoplasia patients. Few studies describe long-term durability outcomes in BE patients who achieve complete eradication of intestinal metaplasia (CE-IM) following EET. We aimed to evaluate the incidence rates (IR) of recurrence of BE with or without neoplasia following CE-IM in patients with at least 5-year follow-up and predictors associated with recurrence.
Methods: The Treatment with Resection and Endoscopic Ablation Techniques for Barrett’s Esophagus (TREAT-BE) Consortium is a multicenter prospective study that enrolls BE patients referred for EET at 4 tertiary care centers in the US. Patient demographics, endoscopic findings and histologic data were recorded. All patients who obtained CE-IM with 5-year follow-up after CE-IM were included. CE-IM was defined as the absence of endoscopically visible BE and IM on biopsies after a single endoscopy. Recurrence was defined as histologic presence of IM with or without neoplasia following CE-IM and reported as any recurrence and recurrence of neoplastic BE. Kaplan-Meier estimates of IRs of recurrence were calculated and were stratified by histology. Factors associated with recurrence were assessed with univariable and multivariable logistic regression analysis.
Results: A total of 152 patients (mean age 63.3 years, 80.9% male, 94.1% white) with a mean follow-up of 87.5 months (SD 22.8) were included (Table 1). Any recurrence was noted in 62 patients (40.8%) with an IR of 7.6 per 100 person-years (95% CI 5.9, 9.7) (Figure 1). Neoplastic recurrence occurred in 15 patients [9.9%; indefinite for dysplasia (IND)/low-grade dysplasia (LGD) 5, high-grade dysplasia (HGD) 6, mucosal esophageal adenocarcinoma (EAC) 4] with an IR of 1.4 per 100 person-years (95% CI 0.9, 2.4). Majority of any recurrence and neoplastic recurrences occurred within 26 and 13 months after CE-IM, respectively. The latest neoplastic recurrence occurred 10.2 years post-CE-IM. Thirteen (86.7%) patients with neoplastic recurrence underwent EET with secondary CE-IM in all patients and 2 patients (13.3%) were lost to follow-up prior to EET. Baseline histology of HGD/EAC was associated an increased IR of any recurrence (Rate Ratio 2.7, 95% CI 1.6, 4.5; p < 0.001). Similarly, baseline histology of HGD/EAC was associated with increased likelihood of recurrence (adjusted odds ratio 3.3; 95% CI 1.5, 7.3) compared to a baseline histology of non-dysplastic BE (NDBE), IND or LGD.
Conclusion: Results of this long-term multicenter, prospective study demonstrates a low incidence of neoplastic recurrence among BE patients who achieved CE-IM following EET. The majority of these recurrences can be managed with repeat EET. Surveillance after EET benefits those with baseline HGD/EAC the most and clinicians should concentrate on retaining these patients in endoscopic surveillance programs.

Sridevi Pokala

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