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Gut. 2014 Oct;63(10):1535-43. doi: 10.1136/gutjnl-2013-305538. Epub 2014 Jan 3.

Long-term recurrence of neoplasia and Barrett's epithelium after complete endoscopic resection.

Author information

  • 1Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • 2Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Division of Gastroenterology, Department of Internal Medicine, Assiut University, Assiut, Egypt.
  • 3Department of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • 4Department of Pathology, Charité University Hospital, Berlin, Germany.
  • 5Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Gastrozentrum, Hirslanden Clinic, Zürich, Switzerland.
  • 6Department of Gastroenterology, Charité University Hospital, Berlin, Germany.
  • 7Department of Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • 8Department of Surgery, Charité University Hospital, Berlin, Germany.
  • 9VA Medical Center, White River Junction, Vermont, USA.

Abstract

BACKGROUND:

Current endoscopic therapy for neoplastic Barrett's oesophagus (BO) consists of complete resection/ablation of all Barrett's tissue including neoplastic lesions. Recurrence seems to be frequent after thermal therapy, such as radiofrequency ablation.

OBJECTIVE:

To analyse long-term recurrence of neoplasia and BO after successful widespread endoscopic mucosal resection (EMR).

DESIGN:

In a retrospective analysis, all patients undergoing widespread EMR of neoplastic BO between 2002 and 2007 at two referral centres were followed for at least 3 years after completion of endotherapy. Recurrence was diagnosed if neoplasia and/or BO were detected following previous successful complete removal, defined as at least two negative endoscopies and biopsies.

RESULTS:

Ninety patients undergoing widespread EMR were included (mean age 63 years; 82 male), 58% of whom underwent additional thermal ablation for minor residual disease. Complete eradication of neoplasia and Barrett's tissue was achieved in 90% of patients. On further follow-up (mean 64.8 months), recurrence of neoplastic and non-neoplastic BO was found in 6.2% and 39.5%, respectively. Recurring neoplasia (3 adenocarcinomas, 1 low-grade and 1 high-grade dysplasia) were found after a median of 44 months (range 38-85) and could be retreated endoscopically. In a multivariate analysis, Barrett's length was the only factor significantly associated with recurrence (OR 2.73).

CONCLUSIONS:

Even after seemingly complete endoscopic resection, recurrence of BO is frequent and independent of additional thermal therapy. Due to the possibility of neoplasia recurrence even after long disease-free intervals, follow-up should be extended beyond 5 years.

KEYWORDS:

Barrett's Carcinoma; Barrett's Oesophagus; Endoscopy

PMID:
24389236
DOI:
10.1136/gutjnl-2013-305538
[PubMed - indexed for MEDLINE]
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