Abstract
Background and aims
Multimodal endoscopic treatment for Barrett’s esophagus (BE) related high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) is safe and effective. However, there is a paucity of data to predict the response to endoscopic treatment. This study aimed to identify predictors of failure to achieve complete eradication of neoplasia (CE-N) and complete eradication of intestinal metaplasia (CE-IM).
Methods
We performed a retrospective analysis of prospectively collected data of all HGD/EAC cases treated endoscopically at a tertiary referral center. Only patients with confirmed HGD/EAC from initial endoscopic mucosal resection (EMR) were included. Potential predictive variables including clinical characteristics, endoscopic features, and index histologic parameters of the EMR specimens were evaluated using multivariate Cox regression.
Results
A total of 457 patients were diagnosed with HGD/EAC by initial EMR from January 2008 to January 2019. Of these, 366 patients who underwent subsequent endoscopic treatment with or without RFA were included. Cumulative incidence rates at 3 years for CE-N and CE-IM were 91.4% (95% CI 87.8–94.2%) and 66.8% (95% CI 61.2–72.3%), respectively during a median follow-up period of 35 months. BE segment of 3–10 cm (HR 0.45; 95% CI 0.36–0.57) and > 10 cm (HR 0.25; 95% CI 0.15–0.40) were independent clinical predictors associated with failure to achieve CE-N. With respect to CE-IM, increasing age (HR 0.88; 95% CI 0.78–1.00) was another predictor along with BE segment of 3–10 cm (HR 0.37; 95% CI 0.28–0.49) and > 10 cm (HR 0.15; 95% CI 0.07–0.30). Lymphovascular invasion increased the risk of CE-N and CE-IM failure in EAC cases.
Conclusion
Failure to achieve CE-N and CE-IM is associated with long-segment BE and other clinical variables. Patients with these predictors should be considered for a more intensive endoscopic treatment approach at expert centers.
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Abbreviations
- BE:
-
Barrett’s esophagus
- BMI:
-
Body mass index
- CE-N:
-
Complete eradication of neoplasia
- CE-IM:
-
Complete eradication of intestinal metaplasia
- CI:
-
Confidence intervals
- EMR:
-
Endoscopic mucosal resection
- ESD:
-
Endoscopic submucosal dissection
- EAC:
-
Esophageal adenocarcinoma
- GERD:
-
Gastroesophageal reflux disease
- GEJ:
-
Gastroesophageal junction
- HGD:
-
High-grade dysplasia
- IM:
-
Intestinal metaplasia
- IQR:
-
Interquartile range
- IMC:
-
Intramucosal cancer
- LVI:
-
Lymphovascular invasion
- PDT:
-
Photodynamic therapy
- PPI:
-
Proton pump inhibitor
- RFA:
-
Radiofrequency ablation
- SD:
-
Standard deviation
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Study conception and design: YS, YI, RK, CT; data acquisition: YS, YI, RK, NM, SR; analysis and interpretation of data: ERS, YS, YI, RK; drafting of the manuscript: YS, YI, RK, ERS, CT; critical revision of the manuscript for important intellectual content: JDM, GRM, GK, PK, NM, CWT; final manuscript approval: all authors approved the final manuscript.
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Yuto Shimamura, Yugo Iwaya, Ryosuke Kobayashi, Enrique Rodriguez de Santiago, Niroshan Muwanwella, Spiro Raftopoulos, Jeffrey D. Mosko, Gary R May, Gabor Kandel, Paul Kortan, Norman Marcon, and Christopher W. Teshima have no conflicts of interest or financial ties to disclose.
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Shimamura, Y., Iwaya, Y., Kobayashi, R. et al. Clinical and pathological predictors of failure of endoscopic therapy for Barrett’s related high-grade dysplasia and early esophageal adenocarcinoma. Surg Endosc 35, 5468–5479 (2021). https://doi.org/10.1007/s00464-020-08037-x
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DOI: https://doi.org/10.1007/s00464-020-08037-x