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Incidence and Predictors of Adenocarcinoma Following Endoscopic Ablation of Barrett’s Esophagus

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Abstract

Background

The rate and risk factors of recurrent or metachronous adenocarcinoma following endoscopic ablation therapy in patients with Barrett’s esophagus (BE) have not been specifically reported.

Aim

The aim of this study was to determine the incidence and predictors of adenocarcinoma after ablation therapy for BE high-grade dysplasia (HGD) or intramucosal carcinoma (IMC).

Methods

This is a single center, retrospective review of prospectively collected data on consecutive cases of endoscopic ablation for BE. A total of 223 patients with BE (HGD or IMC) were treated by ablation between 1996 and 2011. Primary outcome measures were recurrence and new development of adenocarcinoma after ablation. Recurrence was defined as the presence of adenocarcinoma following the absence of adenocarcinoma in biopsy samples from two consecutive surveillance endoscopies. Logistic regression analysis was performed to assess predictors of adenocarcinoma after ablation.

Results

One hundred and eighty-three patients were included in the final analysis, and 40 patients were excluded: 22 for palliative ablation, eight lost to follow-up, five for residual carcinoma and five for postoperative state. Median follow-up was 39 months. Recurrence or new development of adenocarcinoma was found in 20 patients (11 %) and the median time to recurrence/development of adenocarcinoma was 11.5 months. Independent predictors of recurrent or metachronous adenocarcinoma were hiatal hernia size ≥ 4 cm (odds ratio 3.649, P = 0.0233) and histology (HGD/adenocarcinoma) after first ablation (odds ratio 4.141, P = 0.0065).

Conclusions

Adenocarcinoma after endoscopic therapy for HGD or IMC in BE is associated with large hiatal hernia and histology status after initial ablation therapy.

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Acknowledgments

This work was supported in part by the National Institutes of Health (R01CA140574 and U01CA152926 to C.H.).

Conflict of interest

None.

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Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, USA

    Kazuhiro Yasuda & David W. Rattner

  2. Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA

    Sung Eun Choi, Angela C. Tramontano & Chin Hur

  3. Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA

    Norman S. Nishioka, William P. Puricelli & Chin Hur

  4. Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan

    Kazuhiro Yasuda

  5. Oita University, Oita, Japan

    Seigo Kitano

Authors
  1. Kazuhiro Yasuda
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  2. Sung Eun Choi
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  3. Norman S. Nishioka
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  4. David W. Rattner
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  5. William P. Puricelli
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  6. Angela C. Tramontano
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  7. Seigo Kitano
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  8. Chin Hur
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Correspondence to Kazuhiro Yasuda.

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Yasuda, K., Choi, S.E., Nishioka, N.S. et al. Incidence and Predictors of Adenocarcinoma Following Endoscopic Ablation of Barrett’s Esophagus. Dig Dis Sci 59, 1560–1566 (2014). https://doi.org/10.1007/s10620-013-3002-5

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  • DOI: https://doi.org/10.1007/s10620-013-3002-5

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