Recurrence Is Rare Following Complete Eradication of Intestinal Metaplasia in Patients With Barrett's Esophagus and Peaks at 18 Months

Sachin Wani*, Samuel Han, Vladimir Kushnir, Dayna Early, Daniel Mullady, Hazem Hammad, Brian Brauer, Adarsh Thaker, Violette Simon, Eze Ezekwe, Thomas Hollander, Mariah Wood, Amit Rastogi, Steven Edmundowicz, V. Raman Muthusamy, Srinadh Komanduri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Background & Aims: There have been few studies describing the long-term durability of complete eradication of intestinal metaplasia (CE-IM) in patients with Barrett's esophagus (BE)-related neoplasia who received endoscopic eradication therapy (EET). Data are needed to guide surveillance interval protocols and identify patients at risk for recurrence. We assessed the rate of recurrence of intestinal metaplasia and dysplasia, histologic features, and outcomes after recurrence of CE-IM, and identified factors associated with recurrence. Methods: We performed a prospective study of 807 patients with BE who underwent EET, which produced CE-IM, at 4 tertiary-care referral centers, from January 2013 to October 2018. Kaplan-Meier estimates of cumulative incidence rates (IR) of recurrence were calculated for up to 5 years following CE-IM and were stratified by baseline level of histology. Density estimates of recurrence were used to determine the change in the rate of recurrence over time. We conducted logistic regression analysis to identify factors associated with recurrence. Results: Intestinal metaplasia recurred in 121 patients (15%; IR, 5.2/100 person-years), and dysplasia recurred in 41 patients (5.1%; IR, 1.8/100 person-years), after a median follow-up time of 2317 person-years. The rate of recurrence was not constant and the time to any recurrence converged to a normal distribution; recurrences peaked at 1.6 y after patients had CE-IM. Baseline high-grade dysplasia or intramucosal cancer (adjusted odds ratio [aOR], 4.19), presence of reflux symptoms (aOR, 12.1) or hiatal hernia (aOR, 13.8), and number of sessions required to achieve CE-IM (aOR, 1.8) were associated with recurrence. Conclusions: In a prospective study of a large cohort of patients with BE undergoing EET, we found a low rate of recurrence after CE-IM. The rate of recurrence peaked at 1–2 y after CE-IM. These findings indicate that aggressive surveillance might not be necessary more than 1 y after CE-IM and should be considered in surveillance guidelines. Clinicaltrials.gov no: NCT02634645.

Original languageEnglish (US)
Pages (from-to)2609-2617.e2
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number11
DOIs
StatePublished - Oct 2020

Funding

Funding This study was funded by the American Gastroenterological Association Research Scholar Award in GERD and Barrett’s Esophagus, the University of Colorado Department of Medicine Outstanding Early Scholars Program (S.W.), and NIH T32DK007038 (S.H.).

Keywords

  • Esophageal Cancer
  • Predictors
  • Response to Treatment
  • Risk Factor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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