INTRODUCTION Endoscopic eradication therapy with radiofrequency ablation (RFA) and endoscopic mucosal resection is a safe and effective treatment for Barrett's esophagus. Although the outcomes of surveillance endoscopy after successful endoscopic eradication therapy have been described, no previous studies have modeled the natural history or the effect of surveillance endoscopy after successful ablation to prevent progression to invasive esophageal adenocarcinoma. METHODS The US RFA Registry is a multicenter registry consisting of patients treated with RFA for Barrett's esophagus at 148 institutions (113 community-based and 35 academic-affiliated). The authors fit models to impute the natural history of recurrence and neoplastic progression after any recurrence or retreatment. Natural history estimates of invasive adenocarcinoma after ablation therapy were compared with as-treated estimates at 5 years to derive the preventive risk difference for surveillance. RESULTS Natural history estimates for the postablation progression of high-grade dysplasia (HGD) or intramucosal adenocarcinoma to invasive adenocarcinoma after treatment were 6.3% at 5 years compared with 1.3% for low-grade dysplasia (LGD). The natural history model found a much higher preventative risk difference for surveillance for HGD/intramucosal adenocarcinoma (-4.8%), compared with LGD (-1.1%). The numbers needed to surveil at 5 years were 21 and 90 for these groups, respectively, to prevent one case of invasive esophageal adenocarcinoma, making surveillance after successful ablation of baseline HGD more than 4 times as effective at preventing invasive cancer than after successful ablation of baseline LGD. DISCUSSION Endoscopic surveillance after successful ablation of baseline HGD or intramucosal cancer is much more effective than surveillance after successful treatment of baseline LGD in averting invasive adenocarcinoma. Although the modest benefits of surveillance for treated LGD may be greater than the risks for patients at average risk for adverse effects of endoscopy, clinicians should concentrate on retaining patients with baseline HGD or cancer in endoscopic surveillance programs.

中文翻译：

---

巴雷特食管治疗后的监测对患有高度不典型增生或粘膜内癌的患者最有利。

引言 射频消融（RFA）和内镜下粘膜切除术的内镜根除治疗是治疗巴雷特食管的安全有效的方法。尽管已经描述了成功内镜根除治疗后监测内窥镜检查的结果，但之前没有研究模拟成功消融后监测内窥镜检查的自然史或效果，以防止进展为侵袭性食管腺癌。方法 美国 RFA 登记处是一个多中心登记处，由 148 个机构（113 个社区机构和 35 个学术附属机构）接受 RFA 治疗 Barrett 食管的患者组成。作者拟合模型来估算任何复发或再治疗后的复发和肿瘤进展的自然史。将消融治疗后侵袭性腺癌的自然史估计值与 5 年治疗时的估计值进行比较，得出监测的预防风险差异。结果 治疗后 5 年时，高度不典型增生 (HGD) 或粘膜内腺癌进展为侵​​袭性腺癌的自然史估计为 6.3%，而低度不典型增生 (LGD) 为 1.3%。自然史模型发现，与 LGD (-1.1%) 相比，HGD/粘膜内腺癌 (-4.8%) 监测的预防风险差异要高得多。为了预防一例侵袭性食管腺癌，这些组需要进行 5 年监测的人数分别为 21 人和 90 人，成功消融基线 HGD 后进行监测，预防浸润性癌症的效果是成功消融基线 LGD 后的 4 倍以上。讨论 成功消融基线 HGD 或粘膜内癌后的内镜监测比成功治疗基线 LGD 后的监测更有效，可以避免侵袭性腺癌。尽管监测治疗 LGD 的适度益处可能大于内窥镜不良反应平均风险患者的风险，但临床医生应集中精力在内窥镜监测计划中保留基线 HGD 或癌症患者。讨论 成功消融基线 HGD 或粘膜内癌后的内镜监测比成功治疗基线 LGD 后的监测更有效，可以避免侵袭性腺癌。尽管监测治疗 LGD 的适度益处可能大于内窥镜不良反应平均风险患者的风险，但临床医生应集中精力在内窥镜监测计划中保留基线 HGD 或癌症患者。讨论 成功消融基线 HGD 或粘膜内癌后的内镜监测比成功治疗基线 LGD 后的监测更有效，可以避免侵袭性腺癌。尽管监测治疗 LGD 的适度益处可能大于内窥镜不良反应平均风险患者的风险，但临床医生应集中精力在内窥镜监测计划中保留基线 HGD 或癌症患者。