Recurrence risk constant after ablation in Barrett's esophagus

By David Douglas

NEW YORK (Reuters Health) - 5/2/2019

Diligent surveillance remains important after remission of intestinal metaplasia (CRIM) following radiofrequency ablation (RFA) in Barrett's esophagus, researchers say.

In a January 11 online paper in Gut, Dr. Prasad G. Iyer and colleagues note there is some suggestion that recurrence rates are highest in the year after remission and may decline thereafter - but there is a dearth of evidence on the matter.

To investigate further, the researchers examined prospectively maintained databases in the UK and U.S. and identified 594 patients who achieved CRIM. Over a median follow-up of 2.68 years, 151 developed recurrent BE.

The cumulative recurrence risk of any BE within two years was 19%. Over the next 8.6 years there was an additional risk of 49%. In fact, say the investigators "There was no evidence of a clinically meaningful change in the recurrence hazard rate of any BE, dysplastic BE or high grade dysplasia/cancer over the duration of follow-up."

BE recurred most often (74%) at the gastroesophageal junction. About a quarter of those recurrences were dysplastic and 40.8% of them were not visible endoscopically. Moreover, in the absence of visual recurrences, the yield of neosquamous epithelium biopsies from the tubular esophagus was below 1%, suggesting that their requirement "in the absence of visible recurrence may need to be re-evaluated."

Dr. Iyer, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health by email, "Recurrence rates do not appear to decrease with time indicating that we need to be vigilant about recurrence and continue endoscopic surveillance at least once a year for five years."

Because most recurrences appear in the gastroesophageal junction, he stressed, "sampling the GEJ is important." Also, "Most recurrences in the esophagus are visible and the yield of random biopsies in the absence of visible lesions is very low."

Commenting by email, Dr. Prateek Sharma of the University of Kansas Medical Center, Kansas City, told Reuters Health, "This study confirms that recurrences of disease post endoscopic therapy for Barrett's esophagus remain a reality."

Dr. Sharma, who was not involved in the study and is a professor in the Department of Gastroenterology, Hepatology & Motility, concluded, "The majority of recurrent disease occurs in the distal esophagus; the presence of intestinal metaplasia at the gastroesophageal junction post therapy is of questionable significance."

SOURCE: http://bit.ly/2SrSLnY Gut 2019.

IMAGE CREDIT: SCIEPRO

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