Timeline and location of recurrence following successful ablation in Barrett’s oesophagus: an international multicentre study

Sami, Sarmed S.; Ravindran, Adharsh; Kahn, Allon; Snyder, Diana; Santiago, Jose; Ortiz-Fernandez-Sordo, Jacobo; Tan, Wei Keith; Heckman, Michael; Dierkhising, Ross; Johnson, Michele; Lansing, Ramona; Wang, Kenneth; Ragunath, Krish; di Pietro, Massimiliano; Wolfsen, Herbert; Ramirez, Francisco; Fleischer, David; Leggett, Cadman L.; Katzka, David; Iyer, Prasad G.

Abstract

Objectives: Surveillance intervals protocols after complete remission of intestinal metaplasia (CRIM) post radiofrequency ablation (RFA) in Barrett’s esophagus (BE) are currently empiric and not based on substantial evidence. We aimed to assess the timeline, location, and patterns of recurrence following CRIM to inform these guidelines.

Design: Data on patients undergoing RFA for BE were obtained from prospectively maintained databases of five (three United States and 2 United Kingdom) tertiary referral centers. RFA was performed till CRIM was confirmed on two consecutive endoscopies.

Results: 594 patients achieved CRIM as of May 1st 2017. 151 subjects developed recurrent BE over a median (IQR) follow up of 2.8 (1.4-4.4) years. There was 19% recurrence risk of any BE within 2 years and an additional 49% risk over the next 8.6 years. The recurrence hazard rate of any BE, dysplastic BE, and high grade dysplasia/cancer remained constant over the duration of follow-up (p=0.74, p=0.94, and p=0.88; respectively). 74% of BE recurrences developed at the gastroesophageal junction (GEJ) (24.1% were dysplastic) and 26% in the tubular esophagus. The yield of esophageal random biopsies from the tubular esophagus, in the absence of visible lesions, was 1% (BE) and 0.2% (any dysplasia recurrence).

Conclusions: BE recurrence risk following CRIM remained constant over time, suggesting that lengthening of follow up intervals, at least in the first five years after CRIM, may not be advisable. Sampling the GEJ is critical to detecting recurrence. The requirement for random biopsies of the neo-squamous epithelium in the absence of visible lesions may need to be re-evaluated.

Citation

Sami, S. S., Ravindran, A., Kahn, A., Snyder, D., Santiago, J., Ortiz-Fernandez-Sordo, J., Tan, W. K., Heckman, M., Dierkhising, R., Johnson, M., Lansing, R., Wang, K., Ragunath, K., di Pietro, M., Wolfsen, H., Ramirez, F., Fleischer, D., Leggett, C. L., Katzka, D., & Iyer, P. G. (2019). Timeline and location of recurrence following successful ablation in Barrett’s oesophagus: an international multicentre study. Gut, 68(8), 1379-1385. https://doi.org/10.1136/gutjnl-2018-317513

• Journal Article Type: Article
• Acceptance Date: Dec 17, 2018
• Online Publication Date: Jan 11, 2019
• Publication Date: Jan 11, 2019
• Deposit Date: Jan 17, 2019
• Publicly Available Date: Jan 18, 2019
• Journal: Gut
• Print ISSN: 0017-5749
• Electronic ISSN: 1468-3288
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 68
• Issue: 8
• Pages: 1379-1385
• DOI: https://doi.org/10.1136/gutjnl-2018-317513
• Keywords: Barrett’s esophagus, Ablation, Esophageal adenocarcinoma, Recurrence, Timeline, Predictors
• Public URL: https://nottingham-repository.worktribe.com/output/1463825
• Publisher URL: https://gut.bmj.com/content/early/2019/01/11/gutjnl-2018-317513
• Contract Date: Jan 17, 2019