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Predictors of recurrence of dysplasia or cancer in patients with dysplastic Barrett’s esophagus following complete eradication of dysplasia: a single-center retrospective cohort study

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Abstract

Background and aims

Endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) for Barrett’s esophagus (BE)-related high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) are considered effective treatments for eradication of BE. Little is known about the impact of achieving complete eradication of intestinal metaplasia (CE-IM) following the complete eradication of neoplasia (CE-N), specifically if CE-IM reduces the risk of recurrent dysplasia.

Methods

Retrospective cohort study of consecutive patients with BE and HGD or intramucosal cancer (IMC)-treated endoscopically at a tertiary referral center between 2001 and 2019. Association between CE-IM and recurrent dysplasia after CE-N was evaluated.

Results

A total of 433 patients treated with EMR and/or RFA were included. Of these, 381 (88%) achieved CE-N, of which 345 (80%) had adequate follow-up for inclusion in the analysis. A total of 266 (77%) patients achieved CE-IM; with a median follow-up since initial treatment for HGD/IMC of 45.9 months (IQR 25.9, 93.1); 20 patients (5.8%) had recurrent dysplasia after achieving CE-N. Kaplan Meier survival curves revealed that time free of recurrence in those who achieved CE-IM was significantly higher (p = 0.002). In the multivariable analysis, CE-IM was associated with a significant lower hazard of recurrence (HR 0.2, 95% CI 0.1, 0.6), whereas the number of endoscopic treatments to achieve CE-N was associated with a significant higher hazard of recurrence (HR 1.1, 95% CI 1.0, 1.2).

Conclusion

Achieving CE-IM following CE-N reduces the risk of recurrent dysplasia and should be considered a treatment target among patients with BE undergoing endoscopic therapies for HGD or EAC.

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Abbreviations

BE:

Barrett’s esophagus

BMI:

Body mass index

CE-N:

Complete eradication of neoplasia

CE-IM:

Complete eradication of intestinal metaplasia

CI:

Confidence intervals

EMR:

Endoscopic mucosal resection

EAC:

Esophageal adenocarcinoma

GERD:

Gastroesophageal reflux disease

GEJ:

Gastroesophageal junction

HGD:

High-grade dysplasia

IM:

Intestinal metaplasia

IQR:

Interquartile range

IMC:

Intramucosal cancer

LGD:

Low-grade dysplasia

PPI:

Proton pump inhibitor

RFA:

Radiofrequency ablation

SD:

Standard deviation

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Ryosuke Kobayashi, Norman Marcon, Yugo Iwaya, Yuto Shimamura, Hirokazu Honda, Jeffrey Mosko, Gary May & Christopher Teshima

  2. Department of Medicine, Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

    Natalia Causada Calo

  3. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

    Catherine Streutker

Authors
  1. Ryosuke Kobayashi
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  2. Natalia Causada Calo
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  3. Norman Marcon
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  4. Yugo Iwaya
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  5. Yuto Shimamura
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  6. Hirokazu Honda
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  7. Catherine Streutker
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  8. Jeffrey Mosko
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  9. Gary May
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  10. Christopher Teshima
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Contributions

Study conception and design: RK, NCC, CT. Data acquisition: RK, YI, YS, NCC. Analysis and interpretation of data: NCC, RK, CT. Drafting of the manuscript: NCC, RK, CT. Critical revision of the manuscript for important intellectual content: all authors. Final manuscript approval: All authors approved the final manuscript.

Corresponding author

Correspondence to Ryosuke Kobayashi.

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Disclosures

Drs. Ryosuke Kobayashi, Natalia Causada Calo, Norman Marcon, Yugo Iwaya, Yuto Shimamura, Hirokazu Honda, Catherine Streutker, Jeffery Mosko, Gary May, Chrisopher Teshima have no conflicts of interest or financial ties to disclose.

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Kobayashi, R., Calo, N.C., Marcon, N. et al. Predictors of recurrence of dysplasia or cancer in patients with dysplastic Barrett’s esophagus following complete eradication of dysplasia: a single-center retrospective cohort study. Surg Endosc 36, 5041–5048 (2022). https://doi.org/10.1007/s00464-021-08864-6

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