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Endotherapy in case of relapse of neoplastic Barrett’s esophagus after successful initial endoscopic resection

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Abstract

Background

Endotherapy in cases of neoplastic Barrett esophagus (BE) relapse after successful initial endoscopic management is commonly accepted, but few studies analyze this topic and also take into account the metachronous lesions.

Aims

To evaluate the efficiency of endotherapy in the case of neoplastic BE relapse after successful complete endoscopic eradication of neoplastic BE and metaplastic BE.

Methods

Retrospective review of medical records was collected in a computerized and prospective manner between 2000 and 2015, in a single tertiary care center. Recurrence was defined by histological presence of high-grade dysplasia or superficial adenocarcinoma at least 6 months after the end of successful initial endotherapy.

Results

Eighteen patients were assessed (1F/17 M). Delay between initial treatment and relapse was 16.6 months (range 6–33). Endotherapy for relapse obtained a sustained and complete remission for 8/18 (44%) patients, with an average endoscopic follow-up of 28 months. The complication rate of endotherapy was 6%. Surgical management was required in 33% (2 pT2N0M0, 2 pTisN0M0, 1 pTm2N0M0 and 1 pTm3N0M0) and salvage radiochemotherapy in 17% (3/18). One patient treated by 6 sessions of ER was considered as a failure given the multiple sessions of endotherapy. Multivariate analysis showed that length of BE (>5 cm), late stenosis adverse events and the quality of vertical margin during initial ER are predictive factors for disease-free survival (p value < 0.01, Hazard Ratio up to 0.076).

Conclusion

Endotherapy could be a treatment for management of neoplastic BE relapse, but should be carefully used, with strict follow-up.

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Abbreviations

APC:

Argon plasma coagulation

BE:

Barrett esophagus

EMR:

Endoscopic mucosal resection

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

HGD:

High-grade dysplasia

IMC:

Intramucosal carcinoma

RC:

Radiochemotherapy

RF:

Radiofrequency

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Author contributions

SG was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support; FC was involved in study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, technical or material support and study supervision; AA was involved in biostatistics; EB and CP were involved in critical revision of the manuscript for important intellectual content and technical or material support; JPR and CDE were involved in critical revision of the manuscript for important intellectual content; FP was involved in pathological analysis; MG was involved in study concept and design, critical revision of the manuscript for important intellectual content, technical or material support and study supervision.

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Authors and Affiliations

  1. Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite – BP 156, 13273, Marseille Cedex 9, France

    Sébastien Godat, Fabrice Caillol, Erwan Bories, Christian Pesenti, Jean Philippe Ratone, Chiara De Cassan & Marc Giovannini

  2. Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France

    Aurélie Autret

  3. Division of Pathology, Paoli-Calmettes Institute, Marseille, France

    Flora Poizat

Authors
  1. Sébastien Godat
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  2. Fabrice Caillol
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  3. Aurélie Autret
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  4. Erwan Bories
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  5. Christian Pesenti
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  6. Jean Philippe Ratone
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  7. Chiara De Cassan
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  8. Flora Poizat
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  9. Marc Giovannini
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Correspondence to Sébastien Godat.

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Disclosures

Sébastien Godat, Fabrice Caillol, Aurélie Autret, Erwan Bories, Christian Pesenti, Jean Philippe Ratone, Chiara De Cassan, Flora Poizat and Marc Giovannini have no disclosures relevant to the manuscript.

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Godat, S., Caillol, F., Autret, A. et al. Endotherapy in case of relapse of neoplastic Barrett’s esophagus after successful initial endoscopic resection. Surg Endosc 31, 3703–3710 (2017). https://doi.org/10.1007/s00464-016-5409-5

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  • DOI: https://doi.org/10.1007/s00464-016-5409-5

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