Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

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• 作者：Rajesh Krishnamoorthi ; MD¹ ; Siddharth Singh ; MD¹ ; Karthik Ragunathan ; MD² ; David A. Katzka ; MD¹ ; Kenneth K. Wang ; MD¹ ; Prasad G. Iyer ; MD ; MSc ; FASGE¹ ;
• 关键词：APC ; argon plasma coagulation ; BE ; Barrett&rsquo ; s esophagus ; CRIM ; complete remission of intestinal metaplasia ; DBE ; dysplastic Barrett&rsquo ; s esophagus ; EAC ; esophageal adenocarcinoma ; GEJ ; gastroesophageal junction ; HGD ; high-grade dysplasia ; IM ; intestinal metaplasia ; IR ; incidence rate ; NDBE ; nondysplastic Barrett&rsquo ; s esophagus ; PDT ; photodynamic therapy ; RFA ; radiofrequency ablation
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：83
• 期：6
• 页码：1090-1106.e3
• 全文大小：2406 K

文摘

Previous estimates of incidence of intestinal metaplasia (IM) recurrence after achieving complete remission of IM (CRIM) through endoscopic therapy of Barrett's esophagus (BE) have varied widely. We performed a systematic review and meta-analysis of studies to estimate an accurate recurrence risk after CRIM.

Methods

We performed a systematic search of multiple literature databases through June 2015 to identify studies reporting long-term follow-up after achieving CRIM through endoscopic therapy. Pooled incidence rate (IR) of recurrent IM, dysplastic BE, and high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) per person-year of follow-up after CRIM was estimated. Factors associated with recurrence were also assessed.

Results

We identified 41 studies that reported 795 cases of recurrence in 4443 patients over 10,427 patient-years of follow-up. This included 21 radiofrequency ablation studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. Pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC after radiofrequency ablation were 9.5% (95% CI, 6.7-12.3), 2.0% (95% CI, 1.3-2.7), and 1.2% (95% CI, .8-1.6) per patient-year, respectively. When all endoscopic modalities were included, pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC were 7.1% (95% CI, 5.6-8.6), 1.3% (95% CI, .8-1.7), and .8% (95% CI, .5-1.1) per patient-year, respectively. Substantial heterogeneity was noted. Increasing age and BE length were predictive of recurrence; 97% of recurrences were treated endoscopically.

Conclusions

The incidence of recurrence after achieving CRIM through endoscopic therapy was substantial. A small minority of recurrences were dysplastic BE and HGD/EAC. Hence, continued surveillance after CRIM is imperative. Additional studies with long-term follow-up are needed.