TY - JOUR
T1 - Clinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett's esophagus
AU - Solfisburg, Quinn S.
AU - Sami, Sarmed S.
AU - Gabre, Joel
AU - Soroush, Ali
AU - Dhaliwal, Lovekirat
AU - Beveridge, Claire
AU - Jin, Zhezhen
AU - Poneros, John M.
AU - Falk, Gary W.
AU - Ginsberg, Gregory G.
AU - Wang, Kenneth K.
AU - Lightdale, Charles J.
AU - Iyer, Prasad G.
AU - Abrams, Julian A.
N1 - Funding Information:
Funding: JG, ZJ, GWF, KKW, PGI, and JAA were supported in part by a U54 award from the National Cancer Institute (U54 CA163004, PI Timothy Wang).
Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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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U2 - 10.1016/j.gie.2020.10.027
DO - 10.1016/j.gie.2020.10.027
M3 - Article
C2 - 33144238
AN - SCOPUS:85100428263
VL - 93
SP - 1250-1257.e3
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 6
ER -