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)
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Abstract
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.
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References25
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#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
view all 32 authors...
Abstract: Background & Aims Studies are needed to determine the mechanism by which Barrett´s esophagus (BE) progresses to esophageal adenocarcinoma (EAC). Notch signaling maintains stem cells in the gastrointestinal tract and is dysregulated during carcinogenesis. We explored the relationship between Notch signaling and goblet cell maturation, a feature of BE, during EAC pathogenesis. Methods We measured goblet cell density and levels of Notch mRNAs in BE tissues from 164 patients, with and with...
11 CitationsSource
#1Allon Kahn (Mayo Clinic)H-Index: 8
#2Nicholas J. Shaheen (UNC: University of North Carolina at Chapel Hill)H-Index: 82
Last. Prasad G. Iyer (Mayo Clinic)H-Index: 31
view all 3 authors...
Because of the rising incidence and lethality of esophageal adenocarcinoma, Barrett's esophagus (BE) is an increasingly important premalignant target for cancer prevention. BE-associated neoplasia can be safely and effectively treated with endoscopic eradication therapy (EET), incorporating tissue resection and ablation. Because EET has proliferated, managing patients after complete eradication of intestinal metaplasia has taken on increasing importance. Recurrence after complete eradication of ...
4 CitationsSource
#1Wei Keith Tan (University of Cambridge)H-Index: 3
#2Nicholas J. Shaheen (UNC: University of North Carolina at Chapel Hill)H-Index: 82
1 CitationsSource
#1Sarmed S. Sami (Mayo Clinic)H-Index: 12
#2Adharsh Ravindran (Mayo Clinic)H-Index: 3
Last. Prasad G. Iyer (Mayo Clinic)H-Index: 31
view all 21 authors...
Objective Surveillance interval protocols after complete remission of intestinal metaplasia (CRIM) post radiofrequency ablation (RFA) in Barrett’s oesophagus (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 USA and two UK) tertiary referral centres. RFA wa...
31 CitationsSource
#1Tarek Sawas (Mayo Clinic)H-Index: 11
#2Mouaz Alsawas (Mayo Clinic)H-Index: 16
Last. David A. Katzka (Mayo Clinic)H-Index: 61
view all 7 authors...
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 revi...
9 CitationsSource
#1Hassan Siddiki (Mayo Clinic)H-Index: 14
#2Dora Lam-Himlin (Mayo Clinic)H-Index: 22
Last. David E. Fleischer (Mayo Clinic)H-Index: 66
view all 10 authors...
Background and Aims There is controversy about finding intestinal metaplasia (IM) of the gastric cardia on biopsy. The most recent American College of Gastroenterology guideline comments that IM cardia is not more common in patients with Barrett’s esophagus (BE). It provides limited guidance on whether the cardia should be treated when patients with BE undergo endoscopic eradication therapy (EET) and whether the cardia should undergo biopsy after ablation. The aims of our study were to determine...
5 CitationsSource
#1Mimi C. Tan (BCM: Baylor College of Medicine)H-Index: 4
#2Kavin Kanthasamy (BCM: Baylor College of Medicine)H-Index: 1
Last. Aaron P. Thrift (BCM: Baylor College of Medicine)H-Index: 5
view all 8 authors...
Background & Aims Radiofrequency ablation (RFA) is effective treatment for Barrett’s esophagus (BE). However, some patients have recurrence after complete eradication of intestinal metaplasia (CEIM). We investigated the incidence of and factors associated with BE recurrence, with or without neoplasia, after RFA and CEIM using data from the national Veterans Affairs (VA) healthcare system. Methods We performed a retrospective cohort study of Veterans with BE treated by RFA from 2005 through 2016 ...
17 CitationsSource
#1David Itskoviz (TAU: Tel Aviv University)H-Index: 3
#2Zohar Levi (TAU: Tel Aviv University)H-Index: 28
Last. Ram Dickman (TAU: Tel Aviv University)H-Index: 21
view all 9 authors...
Background Barrett’s esophagus (BE) is a known complication of gastroesophageal reflux disease. In a previous study, we described a high prevalence of intestinal metaplasia (IM) in patients with an irregular Z line. However, the clinical importance of this finding is unclear.
6 CitationsSource
#1Cary C. Cotton (UNC: University of North Carolina at Chapel Hill)H-Index: 19
#2W. Asher Wolf (UNC: University of North Carolina at Chapel Hill)H-Index: 15
Last. Amitabh Chak (Case Western Reserve University)H-Index: 3
view all 36 authors...
Background & Aims The goal of treatment for Barrett's esophagus (BE) with dysplasia is complete eradication of intestinal metaplasia (CEIM). The long-term durability of CEIM has not been well characterized, so the frequency and duration of surveillance are unclear. We report results from a 5-year follow-up analysis of patients with BE and dysplasia treated by radiofrequency ablation (RFA) in the randomized controlled Ablation of Intestinal Metaplasia Containing Dysplasia (AIM) trial. Methods Par...
49 CitationsSource
#1Prashanthi N. Thota (Cleveland Clinic)H-Index: 19
#2Prashanth Vennalaganti (KU: University of Kansas)H-Index: 13
Last. Prateek Sharma (KU: University of Kansas)H-Index: 80
view all 18 authors...
Background & Aims Many patients with a irregular Z line , are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia. Methods We performed a prospective, multicenter cohort study of patients who underwent e...
21 CitationsSource
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#2Esther NieuwenhuisH-Index: 1
Last. Roos E. PouwH-Index: 20
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Objective Radiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting. Design Endoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to...
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#1Eva P.D. Verheij (UvA: University of Amsterdam)
#2Sanne N. van Munster (UvA: University of Amsterdam)H-Index: 4
Last. Roos E. Pouw (UvA: University of Amsterdam)H-Index: 20
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