TY - JOUR
T1 - Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus
AU - Badreddine, Rami J.
AU - Prasad, Ganapathy A.
AU - Wang, Kenneth K.
AU - Wong Kee Song, Louis M.
AU - Buttar, Navtej S.
AU - Dunagan, Kelly T.
AU - Lutzke, Lori S.
AU - Borkenhagen, Lynn S.
N1 - Funding Information:
DISCLOSURE: Supported by NIH grants R01 CA111603-01A1 and R01CA097048 to K.K. Wang and R03CA135991-01 to G.A. Prasad. All other authors disclosed no financial relationship relevant to this publication.
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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U2 - 10.1016/j.gie.2009.08.031
DO - 10.1016/j.gie.2009.08.031
M3 - Article
C2 - 19959164
AN - SCOPUS:77950189549
SN - 0016-5107
VL - 71
SP - 697
EP - 703
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -