Neoplastic Barrett's oesophagus and long-term follow-up after endoscopic therapy: complete histological eradication of Barrett associated with high-grade dysplasia significantly decreases neoplasia relapse

Surg Endosc. 2016 Dec;30(12):5410-5418. doi: 10.1007/s00464-016-4898-6. Epub 2016 Apr 29.

Abstract

Background and aims: Endotherapy (ET) has replaced surgery as the first-line treatment of high-grade dysplasia (HGD)/superficial ECA (ECAs) from Barrett's oesophagus (BO). However, long-term follow-up and predictive factors of relapse are not so well studied. The aim of the following study was to evaluate the efficiency of ET for treatment of HGD/ECAs and to determine factors of long-term efficiency.

Methods: ET procedures were manually reported and registered in a hospital data base from March 2000 to July 2010. Inclusion criteria were HGD/ECA on pre-resection biopsies, complete histological and sufficient oncological resection of HGD/ECAs, and complete macroscopic resection of metaplastic BO. Sixty patients (53 men, mean age = 65 years) were included.

Results: Median follow-up was 66 months [range 42-80]. Complete eradication of residual histological metaplastic BO occurred in 29 patients (48 %). Relapse rate at 36 months was 16.6 % (n = 10) and was unchanged at 60 months of follow-up. There was only one relapse (3.4 %) in case of complete eradication of metaplastic BO and 9 (31 %) in case of incomplete eradication. In univaried and multi-varied analysis, complete eradication of metaplastic BO (p < 0.05) and BO length <5 cm (p < 0.05) were predictive of neoplastic BO non relapse. The length of BO remained a prognostic factor for disease-free survival (DFS). When these preponderant data were cancelled out in multi-varied analysis, complete eradication of BO was a prognostic factor for DFS (p < 0.05).

Conclusion: Complete histological eradication of BO by ET significantly decreases the rate of neoplasia relapse.

Keywords: Barrett’s oesophagus; DHG; ECA; Endoscopic resection; Follow-up.

MeSH terms

  • Adult
  • Aged
  • Barrett Esophagus / pathology
  • Barrett Esophagus / surgery*
  • Biopsy
  • Disease-Free Survival
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophagoscopy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control*
  • Precancerous Conditions / pathology
  • Precancerous Conditions / surgery*
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome