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Long-term recurrence of neoplasia and Barrett's epithelium after complete endoscopic resection
  1. Mario Anders1,
  2. Christina Bähr1,
  3. Muhammad Abbas El-Masry1,2,
  4. Andreas H Marx3,
  5. Martin Koch4,
  6. Stefan Seewald1,5,
  7. Guido Schachschal1,
  8. Andreas Adler6,
  9. Nib Soehendra1,
  10. Jakob Izbicki7,
  11. Peter Neuhaus8,
  12. Heiko Pohl9,
  13. Thomas Rösch1
  1. 1Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  2. 2Division of Gastroenterology, Department of Internal Medicine, Assiut University, Assiut, Egypt
  3. 3Department of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  4. 4Department of Pathology, Charité University Hospital, Berlin, Germany
  5. 5Gastrozentrum, Hirslanden Clinic, Zürich, Switzerland
  6. 6Department of Gastroenterology, Charité University Hospital, Berlin, Germany
  7. 7Department of Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  8. 8Department of Surgery, Charité University Hospital, Berlin, Germany
  9. 9VA Medical Center, White River Junction, Vermont, USA
  1. Correspondence to Professor Thomas Rösch, Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; t.roesch{at}uke.de

Abstract

Background Current endoscopic therapy for neoplastic Barrett's oesophagus (BO) consists of complete resection/ablation of all Barrett's tissue including neoplastic lesions. Recurrence seems to be frequent after thermal therapy, such as radiofrequency ablation.

Objective To analyse long-term recurrence of neoplasia and BO after successful widespread endoscopic mucosal resection (EMR).

Design In a retrospective analysis, all patients undergoing widespread EMR of neoplastic BO between 2002 and 2007 at two referral centres were followed for at least 3 years after completion of endotherapy. Recurrence was diagnosed if neoplasia and/or BO were detected following previous successful complete removal, defined as at least two negative endoscopies and biopsies.

Results Ninety patients undergoing widespread EMR were included (mean age 63 years; 82 male), 58% of whom underwent additional thermal ablation for minor residual disease. Complete eradication of neoplasia and Barrett's tissue was achieved in 90% of patients. On further follow-up (mean 64.8 months), recurrence of neoplastic and non-neoplastic BO was found in 6.2% and 39.5%, respectively. Recurring neoplasia (3 adenocarcinomas, 1 low-grade and 1 high-grade dysplasia) were found after a median of 44 months (range 38–85) and could be retreated endoscopically. In a multivariate analysis, Barrett's length was the only factor significantly associated with recurrence (OR 2.73).

Conclusions Even after seemingly complete endoscopic resection, recurrence of BO is frequent and independent of additional thermal therapy. Due to the possibility of neoplasia recurrence even after long disease-free intervals, follow-up should be extended beyond 5 years.

  • Barrett's Oesophagus
  • Barrett's Carcinoma
  • Endoscopy

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