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LOW INCIDENCE OF RECURRENT NEOPLASTIC BARRETT’S ESOPHAGUS (BE) AFTER SUCCESSFUL ENDOSCOPIC ERADICATION THERAPY (EET): LONG-TERM OUTCOMES FROM A MULTICENTER PROSPECTIVE COHORT STUDY

Date
May 19, 2024
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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.

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Speakers

Speaker Image for Amit Rastogi
University of Kansas School of Medicine and Kansas City VA Medical Center
Speaker Image for Vladimir Kushnir
Washington University School of Medicine
Speaker Image for Dayna Early
Washington University in St. Louis
Speaker Image for Steven Edmundowicz
University of Colorado School of Medicine
Speaker Image for Sri Komanduri
Northwestern University
Speaker Image for Sachin Wani
University of Colorado

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