Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus

Rami J. Badreddine, Prasad G Iyer, Kenneth Ke Ning Wang, Louis M. Wong Kee Song, Navtej Singh Buttar, Kelly T. Dunagan, Lori S. Lutzke, Lynn S. Borkenhagen

Research output: Contribution to journalArticle

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Abstract

Background: The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined. Objective: To determine the rate and predictors of dysplasia/neoplasia recurrence after photodynamic therapy (PDT) in BE. Setting: Retrospective analysis of a prospective cohort of BE patients seen at a specialized BE unit. Methods: Patients underwent a standard protocol assessment with esophagogastroduodenoscopy and 4-quadrant biopsies every centimeter at 3-month intervals after ablation. Recurrence was defined as the appearance of any grade of dysplasia or neoplasia after 2 consecutive endoscopies without dysplasia. Entry histology, demographics, length of BE, presence and length of diaphragmatic hernia, EMR, stricture formation, nonsteroidal anti-inflammatory drug use, smoking, and the presence of nondysplastic BE or squamous epithelium were assessed for univariate associations. Time-to-recurrence analysis was done by using Cox proportional hazards regression. A multivariate model was constructed to establish independent associations with recurrence. Results: A total of 363 patients underwent PDT with or without EMR. Of these, 261 patients were included in the final analysis (44 lost to follow-up, 46 had residual dysplasia, and 12 had no dysplasia at baseline). Indication for ablation was low-grade dysplasia (53 patients, 20%), high-grade dysplasia (152 patients, 58%), and intramucosal cancer (56 patients, 21%). Median follow-up was 36 months (interquartile range 18-79 months). Recurrence occurred in 45 patients. Median time to recurrence was 17 months (interquartile range 8-45 months). Significant predictors of recurrence on the multivariate model were older age (hazard ratio [HR] 1.04, P=.029), presence of residual nondysplastic BE (HR 2.88, P=.012), and a history of smoking (HR 2.68, P=.048). Limitations: Possibility of missing prevalent dysplasia despite aggressive surveillance. Conclusion: Recurrence of dysplasia/neoplasia after PDT ablation is associated with advanced age, smoking, and residual BE.

Original languageEnglish (US)
Pages (from-to)697-703
Number of pages7
JournalGastrointestinal Endoscopy
Volume71
Issue number4
DOIs
StatePublished - Apr 2010

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Barrett Esophagus
Recurrence
Neoplasms
Photochemotherapy
Smoking
Digestive System Endoscopy
Diaphragmatic Hernia
Lost to Follow-Up
Endoscopy
Histology
Pathologic Constriction
Anti-Inflammatory Agents
Epithelium
Demography
Biopsy
Incidence

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus. / Badreddine, Rami J.; Iyer, Prasad G; Wang, Kenneth Ke Ning; Wong Kee Song, Louis M.; Buttar, Navtej Singh; Dunagan, Kelly T.; Lutzke, Lori S.; Borkenhagen, Lynn S.

In: Gastrointestinal Endoscopy, Vol. 71, No. 4, 04.2010, p. 697-703.

Research output: Contribution to journalArticle

Badreddine, Rami J. ; Iyer, Prasad G ; Wang, Kenneth Ke Ning ; Wong Kee Song, Louis M. ; Buttar, Navtej Singh ; Dunagan, Kelly T. ; Lutzke, Lori S. ; Borkenhagen, Lynn S. / Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus. In: Gastrointestinal Endoscopy. 2010 ; Vol. 71, No. 4. pp. 697-703.
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T1 - Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus

AU - Badreddine, Rami J.

AU - Iyer, Prasad G

AU - Wang, Kenneth Ke Ning

AU - Wong Kee Song, Louis M.

AU - Buttar, Navtej Singh

AU - Dunagan, Kelly T.

AU - Lutzke, Lori S.

AU - Borkenhagen, Lynn S.

PY - 2010/4

Y1 - 2010/4

N2 - Background: The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined. Objective: To determine the rate and predictors of dysplasia/neoplasia recurrence after photodynamic therapy (PDT) in BE. Setting: Retrospective analysis of a prospective cohort of BE patients seen at a specialized BE unit. Methods: Patients underwent a standard protocol assessment with esophagogastroduodenoscopy and 4-quadrant biopsies every centimeter at 3-month intervals after ablation. Recurrence was defined as the appearance of any grade of dysplasia or neoplasia after 2 consecutive endoscopies without dysplasia. Entry histology, demographics, length of BE, presence and length of diaphragmatic hernia, EMR, stricture formation, nonsteroidal anti-inflammatory drug use, smoking, and the presence of nondysplastic BE or squamous epithelium were assessed for univariate associations. Time-to-recurrence analysis was done by using Cox proportional hazards regression. A multivariate model was constructed to establish independent associations with recurrence. Results: A total of 363 patients underwent PDT with or without EMR. Of these, 261 patients were included in the final analysis (44 lost to follow-up, 46 had residual dysplasia, and 12 had no dysplasia at baseline). Indication for ablation was low-grade dysplasia (53 patients, 20%), high-grade dysplasia (152 patients, 58%), and intramucosal cancer (56 patients, 21%). Median follow-up was 36 months (interquartile range 18-79 months). Recurrence occurred in 45 patients. Median time to recurrence was 17 months (interquartile range 8-45 months). Significant predictors of recurrence on the multivariate model were older age (hazard ratio [HR] 1.04, P=.029), presence of residual nondysplastic BE (HR 2.88, P=.012), and a history of smoking (HR 2.68, P=.048). Limitations: Possibility of missing prevalent dysplasia despite aggressive surveillance. Conclusion: Recurrence of dysplasia/neoplasia after PDT ablation is associated with advanced age, smoking, and residual BE.

AB - Background: The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined. Objective: To determine the rate and predictors of dysplasia/neoplasia recurrence after photodynamic therapy (PDT) in BE. Setting: Retrospective analysis of a prospective cohort of BE patients seen at a specialized BE unit. Methods: Patients underwent a standard protocol assessment with esophagogastroduodenoscopy and 4-quadrant biopsies every centimeter at 3-month intervals after ablation. Recurrence was defined as the appearance of any grade of dysplasia or neoplasia after 2 consecutive endoscopies without dysplasia. Entry histology, demographics, length of BE, presence and length of diaphragmatic hernia, EMR, stricture formation, nonsteroidal anti-inflammatory drug use, smoking, and the presence of nondysplastic BE or squamous epithelium were assessed for univariate associations. Time-to-recurrence analysis was done by using Cox proportional hazards regression. A multivariate model was constructed to establish independent associations with recurrence. Results: A total of 363 patients underwent PDT with or without EMR. Of these, 261 patients were included in the final analysis (44 lost to follow-up, 46 had residual dysplasia, and 12 had no dysplasia at baseline). Indication for ablation was low-grade dysplasia (53 patients, 20%), high-grade dysplasia (152 patients, 58%), and intramucosal cancer (56 patients, 21%). Median follow-up was 36 months (interquartile range 18-79 months). Recurrence occurred in 45 patients. Median time to recurrence was 17 months (interquartile range 8-45 months). Significant predictors of recurrence on the multivariate model were older age (hazard ratio [HR] 1.04, P=.029), presence of residual nondysplastic BE (HR 2.88, P=.012), and a history of smoking (HR 2.68, P=.048). Limitations: Possibility of missing prevalent dysplasia despite aggressive surveillance. Conclusion: Recurrence of dysplasia/neoplasia after PDT ablation is associated with advanced age, smoking, and residual BE.

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