Clinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett's esophagus.

Published on Oct 31, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.10.027
Quinn Solfisburg1
Estimated H-index: 1
(Columbia University),
Quinn S. Solfisburg1
Estimated H-index: 1
(Columbia University)
+ 11 AuthorsJulian A. Abrams35
Estimated H-index: 35
(Columbia University)
Background and Aims After endoscopic eradication of Barrett’s esophagus (BE), recurrence of intestinal metaplasia at the gastroesophageal junction (GEJIM) is common. The clinical significance of this finding is unclear. We assessed whether recurrent GEJIM is associated with increased risk of subsequent dysplasia and whether endoscopic treatment lowers this risk. Methods A retrospective, multicenter, cohort study was performed of treated BE patients who achieved complete eradication of intestinal metaplasia (IM). Postablation follow-up was performed at standard intervals. Recurrent GEJIM was defined as nondysplastic IM on gastroesophageal junction biopsy specimens without endoscopic evidence of BE. Patients were categorized as “never-GEJIM,” “GEJIM-observed,” or “GEJIM-treated.” Endoscopic treatment for recurrent GEJIM was at the endoscopists’ discretion. The primary outcome was dysplasia recurrence. Analyses were performed using log-rank tests and Cox proportional hazards modeling. Results Six hundred thirty-three patients were analyzed; median follow-up was 47 months (interquartile range, 24-69). Most patients (81%) had high-grade dysplasia or intramucosal adenocarcinoma before treatment. Dysplasia recurrence was 2.2% per year. GEJIM-observed patients had the lowest rate of recurrence (.6%/y) followed by GEJIM-treated (2.2%/y) and never-GEJIM (2.6%/y) (log-rank P = .07). In multivariate analyses, compared with never-GEJIM, the risk of dysplasia recurrence was significantly lower in GEJIM-observed patients (adjusted hazard ratio, .19; 95% confidence interval, .05-.81) and not different in GEJIM-treated patients (adjusted hazard ratio, .81; 95% confidence interval, .39-1.67). Older age and longer initial BE length were independently associated with recurrence. Conclusions Recurrent GEJIM after endoscopic eradication of BE was not associated with an increased risk of subsequent dysplasia. Future studies are warranted to determine if observation is appropriate for this finding.
#1Bettina Kunze (TUM: Technische Universität München)H-Index: 1
#2Frederik Wein (TUM: Technische Universität München)H-Index: 3
Last. Michael Quante (TUM: Technische Universität München)H-Index: 28
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