Background and Aims

Endoscopic eradication therapy (EET) is the main treatment for dysplastic Barrett’s esophagus and intramucosal adenocarcinoma. Although the goal of EET is to achieve complete remission of intestinal metaplasia (CRIM), treatment might achieve complete remission of dysplasia (CR-D) only, without achieving CRIM. Persistent intestinal metaplasia after eradication of dysplasia might carry a higher risk for progression into advanced neoplasia.

Methods

We performed a systematic review and meta-analysis after searching multiple databases to identify studies that evaluated dysplasia recurrence risk after successful eradication of neoplasia with EET. We calculated the pooled cumulative incidence of dysplasia and advanced neoplasia recurrence after CRIM and CR-D only and then compared the two using risk ratios.

Results

Forty studies were included (4410 patients with total follow-up of 12,976 patient-years). A total of 4061 achieved CRIM and 349 achieved CR-D only. The cumulative incidence of CR-D only was 14% (95% confidence interval [CI], 10%-19%). The pooled cumulative incidence of any dysplasia recurrence after achieving CRIM was 5% (95% CI, 3%-7%) and 12% (95% CI, 4%-23%) after achieving CR-D only. Comparing dysplasia detection after achieving CR-D only with CRIM, there was a significantly higher risk for detection after CR-D (risk ratio [RR], 2.8; 95% CI, 1.7-4.6). The pooled cumulative incidence rate of high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) recurrence was 3% (95% CI, 2%-4%) after achieving CRIM and 6% (95% CI, 0%-16%) after achieving CR-D only. Comparing HGD/EAC recurrence after achieving CR-D only with CRIM, there was a significantly higher risk for recurrence after CR-D (RR, 3.6; 95% CI, 1.45-9). When excluding patients who underwent ablation for non-dysplastic Barrett’s esophagus only, these differences persisted with dysplasia recurrence after achieving CR-D only compared with CRIM showing a significantly higher risk for recurrence after CR-D (RR, 2.9; 95% CI, 1.66-5).

Conclusions

CRIM was associated with a lower risk of dysplasia and advanced neoplasia recurrence compared with CR-D only. Achieving CRIM should remain the goal of EET in dysplastic Barrett’s esophagus.

中文翻译：

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内镜根除肿瘤性巴雷特食管治疗后持续的肠上皮化生增加异型增生复发的风险：荟萃分析

背景和目标

内镜根除疗法（EET）是增生性Barrett食管和粘膜内腺癌的主要治疗方法。尽管EET的目标是实现肠上皮化生（CRIM）的完全缓解，但治疗可能仅实现不典型增生（CR-D）的完全缓解，而未达到CRIM。根除不典型增生后的持续性肠上皮化生可能具有发展为晚期肿瘤的更高风险。

方法

我们在搜索多个数据库后进行了系统的综述和荟萃分析，以鉴定评估用EET成功根除瘤形成后不典型增生复发风险的研究。我们仅计算了CRIM和CR-D后合并的不典型增生和晚期赘生物复发的累积累积发生率，然后使用风险比对两者进行了比较。

结果

纳入四十项研究（4410例患者，总随访时间为12,976例患者-年）。仅4061个实现了CRIM，349个实现了CR-D。CR-D的累积发生率仅为14％（95％置信区间[CI]，10％-19％）。仅达到CR-D后，达到CRIM后任何异型增生复发的累积累积发生率分别为5％（95％CI，3％-7％）和12％（95％CI，4％-23％）。将仅达到CR-D的不典型增生检测与仅使用CRIM进行比较，发现CR-D后的异常增生风险显着更高（风险比[RR]为2.8； 95％CI为1.7-4.6）。达到CRIM后，高级别异型增生（HGD）/食管腺癌（EAC）复发的合并累积发生率为3％（95％CI，2％-4％）和6％（95％CI，0％-16％） ），仅在获得CR-D之后。比较仅使用CRIM实现CR-D后的HGD / EAC复发，CR-D术后复发的风险明显更高（RR，3.6； 95％CI，1.45-9）。仅排除非增生性Barrett食道消融的患者时，这些差异仅在达到CR-D后仍与不典型增生复发有关，而与CRIM相比，显示出CR-D后复发的风险显着更高（RR，2.9； 95％CI，1.66） -5）。

结论

与仅CR-D相比，CRIM与不典型增生和晚期赘生物复发的风险较低。在发育不良的巴雷特食管中，实现CRIM应该仍然是EET的目标。