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Gastrointest Endosc. 2018 Dec 7. pii: S0016-5107(18)33343-1. doi: 10.1016/j.gie.2018.11.035. [Epub ahead of print]

Persistent intestinal metaplasia after endoscopic eradication therapy of neoplastic Barrett's esophagus increases the risk of dysplasia recurrence: meta-analysis.

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester.
2
Division of Evidence Based Practice Center, Mayo Clinic, Rochester.
3
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester. Electronic address: Katzka.david@mayo.edu.

Abstract

BACKGROUND AND AIMS:

Endoscopic eradication therapy (EET) is the main treatment for dysplastic Barrett's esophagus and intramucosal adenocarcinoma. Although the goal of EET is to achieve complete remission of intestinal metaplasia (CRIM), treatment might achieve complete remission of dysplasia (CR-D) only, without achieving CRIM. Persistent intestinal metaplasia after eradication of dysplasia might carry a higher risk for progression into advanced neoplasia.

METHODS:

We performed a systematic review and meta-analysis after searching multiple databases to identify studies, which evaluated dysplasia recurrence risk after successful eradication of neoplasia with EET. We calculated pooled cumulative incidence of dysplasia and advanced neoplasia recurrence after CRIM and CR-D only and then compared the 2 using risk ratios.

RESULTS:

Forty studies were included (4410 patients with total follow-up of 12,976 patient-years). A total of 4061 achieved CRIM and 349 CR-D only. The cumulative incidence of CR-D only was 14% (95% CI, 10% - 19%). The pooled cumulative incidence of any dysplasia recurrence after achieving CRIM was 5% ( 95% CI, 3%- 7%) and after achieving CR-D only was 12% (95% CI, 4% - 23%). Comparing dysplasia detection after achieving CR-D only to CRIM showed significantly higher risk for detection after CR-D, risk ratio (RR), 2.8 (95% CI, 1.7 - 4.6). The pooled cumulative incidence rate of high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) recurrence was 3% (95% CI, 2% - 4%) after achieving CRIM and 6% (95% CI, 0% - 16%) after achieving CR-D only. Comparing HGD/EAC recurrence after achieving CR-D only with CRIM showed significantly higher risk for recurrence after CR-D: RR, 3.6 (95% CI, 1.45 - 9). When excluding patients who underwent ablation for NDBE only, these differences persisted with dysplasia recurrence after achieving CR-D only compared with CRIM showing a significantly higher risk for recurrence after CR-D: RR, 2.9 (95% CI, 1.66 - 5).

CONCLUSIONS:

CRIM was associated with lower risk of dysplasia and advanced neoplasia recurrence compared with CR-D only. Achieving CRIM should remain the goal of EET in dysplastic BE.

KEYWORDS:

Barrett’s esophagus; Endoscopic eradication therapy; Persistent Intestinal Metaplasia

PMID:
30529044
DOI:
10.1016/j.gie.2018.11.035

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