Back to Search
Start Over
Recurrence of Barrett's Esophagus is Rare Following Endoscopic Eradication Therapy Coupled With Effective Reflux Control.
- Source :
-
The American journal of gastroenterology [Am J Gastroenterol] 2017 Apr; Vol. 112 (4), pp. 556-566. Date of Electronic Publication: 2017 Feb 14. - Publication Year :
- 2017
-
Abstract
- Objectives: Recent data suggest that effective control of gastroesophageal reflux improves outcomes associated with endoscopic eradication therapy (EET) for Barrett's esophagus (BE). However, the impact of reflux control on preventing recurrent intestinal metaplasia and/or dysplasia is unclear. The aims of the study were: (a) to determine the effectiveness and durability of EET under a structured reflux management protocol and (b) to determine the impact of optimizing anti-reflux therapy on achieving complete eradication of intestinal metaplasia (CE-IM).<br />Methods: Consecutive BE patients referred for EET were enrolled and managed with a standardized reflux management protocol including twice-daily PPI therapy during eradication. Primary outcomes were rates of CE-IM and IM or dysplasia recurrence.<br />Results: Out of 221 patients enrolled (46.0% with high-grade dysplasia/intramucosal carcinoma, 34.0% with low-grade dysplasia, and 20.0% with non-dysplastic BE) an overall CE-IM of 93% was achieved within 11.6±10.2 months. Forty-eight patients did not achieve CE-IM in 3 sessions. After modification of their reflux management, 45 (93.7%) achieved CE-IM in a mean of 1.1 RFA sessions. Recurrence occurred in 13 patients (IM in 10(4.8%), dysplasia in 3 (1.5%)) during a mean follow-up of 44±18.5 months. The only significant predictor of recurrence was the presence of a hiatal hernia. Recurrence of IM was significantly lower than historical controls (10.9 vs. 4.8%, P=0.04).<br />Conclusions: The current study highlights the importance of reflux control in patients with BE undergoing EET. In this setting, EET has long-term durability with low recurrence rates providing early evidence for extending endoscopic surveillance intervals after EET.
- Subjects :
- Aged
Barrett Esophagus prevention & control
Carcinoma in Situ prevention & control
Cohort Studies
Endoscopy, Digestive System
Esophageal Neoplasms prevention & control
Female
Hernia, Hiatal epidemiology
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local epidemiology
Prospective Studies
Recurrence
Risk Factors
Barrett Esophagus surgery
Carcinoma in Situ surgery
Endoscopic Mucosal Resection methods
Esophageal Neoplasms surgery
Gastroesophageal Reflux drug therapy
Neoplasm Recurrence, Local prevention & control
Proton Pump Inhibitors therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1572-0241
- Volume :
- 112
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The American journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 28195178
- Full Text :
- https://doi.org/10.1038/ajg.2017.13