Long-Term Results and Risk Factor Analysis for Recurrence after Curative Endoscopic Therapy in 349 Patients with High-Grade Intraepithelial Neoplasia and Mucosal Adenocarcinoma in Barrett's Oesophagus

Oliver Pech ^1*, Angelika Behrens ¹, Andrea Dinah May ¹, Lars Nachbar ¹, Liebwin Gossner ¹, Thomas Rabenstein ¹, Hendrik Manner ¹, Erwin Guenter ¹, Josephus Huijsmans ¹, Michael Vieth ², Manfred Stolte ² and Christian Ell ¹

¹ HSK Wiesbaden, Germany
² Institut für Pathologie, Klinikum Bayreuth, Germany

^* To whom correspondence should be addressed. E-mail: oliver.pech{at}t-online.de.

Accepted 16 April 2008

Abstract

Objective Endoscopic therapy is increasingly being used for high-grade intraepithelial neoplasia (HGIN) and mucosal adenocarcinoma (BC) in patients with Barrett's oesophagus. This report provides 5-year follow-up data from a large prospective study investigating the efficacy and safety of endoscopic treatment in these patients and analyzing risk factors for recurrence.

Design Prospective cohort study

Setting Academic tertiary care center

Patients Between October 1996 and September 2002, 61 patients with HGIN and 288 with BC were included (173 with short-segment and 176 with long-segment Barrett’s) from a total of 486 patients presenting with Barrett’s neoplasia. Patients with submucosal or more advanced cancer were excluded.

Interventions Endoscopic Therapy

Main outcome measures Rate of complete remission and recurrence rate, tumour-associated death.

Results Endoscopic resection was performed in 279 patients, photodynamic therapy in 55, and both procedures in 13; two patients received argon plasma coagulation. The mean follow-up period was 63.6 ± 23.1 months. Complete response was achieved in 337 patients (96.6%); surgery was necessary in 13 (3.7%) after endoscopic therapy failed. Metachronous lesions developed during the follow-up in 74 patients (21.5%); 56 died of concomitant disease, but none died of BC. The calculated 5-year survival rate was 84%. The risk factors most frequently associated with recurrence were piecemeal resection, long-segment Barrett's, no ablative therapy of Barrett's oesophagus after CR, time until CR achieved >10 months and multifocal neoplasia.

Conclusions This study showed that endoscopic therapy was highly effective and safe, with an excellent long-term survival rate. Risk factors identified may help stratify patients who are at risk for recurrence and those requiring more intensified follow-up.