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Endoscopic eradication, recurrence comparable in BE patients with HGD, IMC
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Eradication and recurrence rates of dysplasia or neoplasia are similar in patients with Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma who receive endoscopic eradication therapy, according to recent study data.
Researchers performed a retrospective cohort study to compare rates of recurrent dysplasia or neoplasia in BE patients with high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) after complete endoscopic eradication of intestinal metaplasia. They also compared recurrence rates between patients who achieved complete eradication of intestinal metaplasia vs. those with persistent intestinal metaplasia, and aimed to ascertain factors associated with lack of response to endoscopic therapy.
A total of 135 patients with HGD and 111 with IMC were referred for multimodal endoluminal therapy from 1998 to March 2013 at the Hospital of the University of Pennsylvania. At the end of the treatment period, complete eradication of intestinal metaplasia was achieved in 83.1% of the HGD group compared with 75.7% of the IMC group. Recurrent dysplasia or neoplasia was observed in 9.5% of IMC patients compared with 8% of HGD patients (RR = 1.2; 95% CI, 0.48-2.98), which remained comparable after 5 years (13.5% vs. 11.4%; RR = 0.85; 95% CI, 0.27-2.7). Recurrent intestinal metaplasia was observed in 34.5% of the HGD group compared with 29.8% of the IMC group, and median time to recurrence was similar (16 vs. 13 months, respectively). Recurrent dysplasia or neoplasia also was comparable between patients with persistent intestinal metaplasia and those who achieved complete eradication (HDG, 9% vs. 8%; RR = 1.14; 95% CI, 0.26-4.98; IMC, 7.4% vs. 9.5%; RR = 0.78; 95% CI, 0.18-3.42). Multivariate analysis showed the only significant risk factors for recurrence were increasing age (per year, adjusted OR = 1.1; 95% CI, 1-1.2) and white ethnicity (adjusted OR = 0.08; 95% CI, 0.01-0.72).
The researchers concluded that these findings “demonstrate the following: (1) endoluminal therapy achieves comparable eradication rates of dysplasia and carcinoma in BE patients with HGD and IMC; (2) after completion eradication, long-term recurrence of dysplasia is similar when treating either HGD or IMC; (3) [intestinal metaplasia] almost invariably returns after eradication, warranting continued surveillance after endoscopic resection and/or ablative therapy; and (4) predictors of poor response to endoscopic therapy remains an area of future investigation.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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