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Endoscopic therapy effective in Barrett’s carcinoma, dysplasia
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ORLANDO — Endoscopic therapy was equally effective in patients with Barrett’s esophagus who had intramucosal carcinoma or high-grade dysplasia, according to research presented at the World Congress of Gastroenterology at ACG 2017.
“Barrett’s esophagus with low-grade dysplasia often progresses to high-grade dysplasia, then intramucosal cancer and eventually on to invasive adenocarcinoma. This known progression provides opportunities to intervene before patients are diagnosed with invasive adenocarcinoma and consideration of endoscopic therapy in Barrett’s esophagus patients with early cancer could reduce the need for invasive therapy,” Rajesh Krishnamoorthi, MD, of Virginia Mason Medical Center, said during his presentation.
The researchers sought to assess and compare the rates of complete eradication of dysplasia and recurrent intestinal metaplasia following endoscopic therapy among 276 patients (median age, 66 years; 84.1% men; median length of Barrett’s esophagus segment, 6 cm) with intramucosal carcinoma (n = 70) or high-grade dysplasia (n = 206).
Researchers used cox-proportional hazards models to assess the success of endoscopy therapy between the two groups. They made adjustments for age, sex and Barrett’s esophagus length.
Results showed no differences in baseline characteristics between the two groups.
Among patients with intramucosal cancer, 81.4% achieved complete eradication of intestinal metaplasia and 88.6% achieved complete eradication of dysplasia. Among those with high-grade dysplasia, 84% achieved complete eradication of intestinal metaplasia and 89.8% achieved complete eradication of dysplasia.
Overall, the researchers observed no statistically significant differences between the proportion of patients who achieved complete eradication of intestinal metaplasia (P = .62) vs. those who achieved complete eradication of dysplasia (P = .77).
After the researchers adjusted for age, sex and Barrett’s esophagus length, they did not find statistically significant differences in the rates of complete eradication of intestinal metaplasia (HR = 1.15; 95% CI, 0.38–3.51) or complete eradication of dysplasia (HR = 1.21; 95% CI, 0.31-4.66) between the two groups.
Nearly 44% of patients with intramucosal cancer had recurrent intramucosal cancer vs. 34.7% of patients with high-grade dysplasia with recurrent intramucosal cancer (P = .21). – by Jennifer Southall
Reference: Krishnamoorthi R, et al. Abstract 5. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.
Disclosure : Krishnamoorthi reports no relevant financial disclosures.