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Meta-Analysis
. 2016 Jun;83(6):1090-1106.e3.
doi: 10.1016/j.gie.2016.02.009. Epub 2016 Feb 20.

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

Rajesh Krishnamoorthi  1 , Siddharth Singh  1 , Karthik Ragunathan  2 , David A Katzka  1 , Kenneth K Wang  1 , Prasad G Iyer  1
Affiliations
Meta-Analysis

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

Rajesh Krishnamoorthi et al. Gastrointest Endosc. 2016 Jun.

Abstract

Background and aims: 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.

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Figures

Figure 1
Figure 1
Flow sheet summarizing study identification and selection.
Figure 2
Figure 2
A, Incidence of recurrent IM after achieving CRIM using any endoscopic modality in patients with BE. B, Incidence of recurrent DBE after achieving CRIM using any endoscopic modality in patients with BE. C, Incidence of recurrent HGD/EAC after achieving CRIM using any endoscopic modality in patients with BE. IM, intestinal metaplasia; CRIM, complete remission of intestinal metaplasia; BE, Barrett's esophagus; HGD/EAC, high-grade dysplasia/esophageal adenocarcinoma.
Figure 2
Figure 2
A, Incidence of recurrent IM after achieving CRIM using any endoscopic modality in patients with BE. B, Incidence of recurrent DBE after achieving CRIM using any endoscopic modality in patients with BE. C, Incidence of recurrent HGD/EAC after achieving CRIM using any endoscopic modality in patients with BE. IM, intestinal metaplasia; CRIM, complete remission of intestinal metaplasia; BE, Barrett's esophagus; HGD/EAC, high-grade dysplasia/esophageal adenocarcinoma.
Figure 2
Figure 2
A, Incidence of recurrent IM after achieving CRIM using any endoscopic modality in patients with BE. B, Incidence of recurrent DBE after achieving CRIM using any endoscopic modality in patients with BE. C, Incidence of recurrent HGD/EAC after achieving CRIM using any endoscopic modality in patients with BE. IM, intestinal metaplasia; CRIM, complete remission of intestinal metaplasia; BE, Barrett's esophagus; HGD/EAC, high-grade dysplasia/esophageal adenocarcinoma.
Figure 3
Figure 3
A, Incidence of recurrent IM after achieving CRIM using RFA in patients with BE. B, Incidence of recurrent DBE after achieving CRIM using RFA in patients with BE. C, Incidence of recurrent HGD/EAC after achieving CRIM using RFA in patients with BE. IM, intestinal metaplasia; CRIM, complete remission of intestinal metaplasia; RFA, radiofrequency ablation; Barrett's esophagus; DBE, dysplastic Barrett's esophagus; HGD/EAC, high-grade dysplasia/esophageal adenocarcinoma.
Figure 3
Figure 3
A, Incidence of recurrent IM after achieving CRIM using RFA in patients with BE. B, Incidence of recurrent DBE after achieving CRIM using RFA in patients with BE. C, Incidence of recurrent HGD/EAC after achieving CRIM using RFA in patients with BE. IM, intestinal metaplasia; CRIM, complete remission of intestinal metaplasia; RFA, radiofrequency ablation; Barrett's esophagus; DBE, dysplastic Barrett's esophagus; HGD/EAC, high-grade dysplasia/esophageal adenocarcinoma.
Figure 4
Figure 4
Funnel plot assessing publication bias in primary analysis.
None
See this image and copyright information in PMC

References

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Supplementary concepts