Background & Aims

There have been few studies describing the long-term durability of complete eradication of intestinal metaplasia (CE-IM) in patients with Barrett’s esophagus (BE)-related neoplasia who received endoscopic eradication therapy (EET). Data are needed to guide surveillance interval protocols and identify patients at risk for recurrence. We assessed the rate of recurrence of intestinal metaplasia and dysplasia, histologic features, and outcomes after recurrence of CE-IM, and identified factors associated with recurrence.

Methods

We performed a prospective study of 807 patients with BE who underwent EET, which produced CE-IM, at 4 tertiary-care referral centers, from January 2013 to October 2018. Kaplan-Meier estimates of cumulative incidence rates (IR) of recurrence were calculated for up to 5 years following CE-IM and were stratified by baseline level of histology. Density estimates of recurrence were used to determine the change in the rate of recurrence over time. We conducted logistic regression analysis to identify factors associated with recurrence.

Results

Intestinal metaplasia recurred in 121 patients (15%; IR, 5.2/100 person-years), and dysplasia recurred in 41 patients (5.1%; IR, 1.8/100 person-years), after a median follow-up time of 2317 person-years. The rate of recurrence was not constant and the time to any recurrence converged to a normal distribution; recurrences peaked at 1.6 y after patients had CE-IM. Baseline high-grade dysplasia or intramucosal cancer (adjusted odds ratio [aOR], 4.19), presence of reflux symptoms (aOR, 12.1) or hiatal hernia (aOR, 13.8), and number of sessions required to achieve CE-IM (aOR, 1.8) were associated with recurrence.

Conclusions

In a prospective study of a large cohort of patients with BE undergoing EET, we found a low rate of recurrence after CE-IM. The rate of recurrence peaked at 1–2 y after CE-IM. These findings indicate that aggressive surveillance might not be necessary more than 1 y after CE-IM and should be considered in surveillance guidelines. Clinicaltrials.gov no: NCT02634645.

中文翻译：

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巴雷特食管患者完全根除肠上皮化生后复发很少见，并且在 18 个月时达到峰值。

背景与目标

很少有研究描述接受内窥镜根除治疗 (EET) 的巴雷特食管 (BE) 相关肿瘤患者完全根除肠上皮化生 (CE-IM) 的长期持久性。需要数据来指导监测间隔协议并识别有复发风险的患者。我们评估了肠上皮化生和发育不良的复发率、组织学特征和 CE-IM 复发后的结果，并确定了与复发相关的因素。

方法

我们对 2013 年 1 月至 2018 年 10 月在 4 个三级医疗转诊中心接受 EET（产生 CE-IM）的 807 名 BE 患者进行了前瞻性研究。 计算了 Kaplan-Meier 对复发累积发生率 (IR) 的估计CE-IM 后长达 5 年，并根据组织学的基线水平进行分层。复发的密度估计用于确定复发率随时间的变化。我们进行了逻辑回归分析以确定与复发相关的因素。

结果

中位随访时间为 2317 人后，121 名患者（15%；IR，5.2/100 人年）和异常增生复发 41 名患者（5.1%；IR，1.8/100 人年） -年。复发率不是恒定的，任何复发的时间都收敛于正态分布；复发率在患者接受 CE-IM 后 1.6 年达到峰值。基线高度不典型增生或粘膜内癌（调整比值比 [aOR]，4.19），存在反流症状（aOR，12.1）或食管裂孔疝（aOR，13.8），以及达到 CE-IM 所需的治疗次数（aOR， 1.8) 与复发有关。

结论

在对接受 EET 的大量 BE 患者进行的一项前瞻性研究中，我们发现 CE-IM 后的复发率较低。复发率在 CE-IM 后 1-2 年达到峰值。这些发现表明，在 CE-IM 后超过 1 年可能没有必要进行积极的监测，应在监测指南中予以考虑。Clinicaltrials.gov 编号：NCT02634645。