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. 2017 Jun;5(6):E430-E449.
doi: 10.1055/s-0043-106578. Epub 2017 May 31.

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett's esophagus: a systematic review and meta-analysis

Larissa L Fujii-Lau  1 , Birtukan Cinnor  2 , Nicholas Shaheen  3 , Srinivas Gaddam  1 , Srinadh Komanduri  4 , V Raman Muthusamy  5 , Ananya Das  6 , Robert Wilson  2 , Violette C Simon  2 , Vladimir Kushnir  1 , Daniel Mullady  1 , Steven A Edmundowicz  2 , Dayna S Early  1 , Sachin Wani  2
Affiliations

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett's esophagus: a systematic review and meta-analysis

Larissa L Fujii-Lau et al. Endosc Int Open. 2017 Jun.

Abstract

Background: Conflicting data exist with regard to recurrence rates of intestinal metaplasia (IM) and dysplasia after achieving complete eradication of intestinal metaplasia (CE-IM) in Barrett's esophagus (BE) patients.

Aim: (i) To determine the incidence of recurrent IM and dysplasia achieving CE-IM and (ii) to compare recurrence rates between treatment modalities [radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) vs stepwise complete EMR (SRER)].

Methods: A systematic search was performed for studies reporting on outcomes and estimates of recurrence rates after achieving CE-IM. Pooled incidence [per 100-patient-years (PY)] and risk ratios with 95 %CI were obtained. Heterogeneity was measured using the I2 statistic. Subgroup analyses, decided a priori, were performed to explore heterogeneity in results.

Results: A total of 39 studies were identified (25-RFA, 13-SRER, and 2 combined). The pooled incidence of any recurrence was 7.5 (95 %CI 6.1 - 9.0)/100 PY with a pooled incidence of IM recurrence rate of 4.8 (95 %CI 3.8 - 5.9)/100 PY, and dysplasia recurrence rate of 2.0 (95 %CI 1.5 - 2.5)/100 PY. Compared to the SRER group, the RFA group had significantly higher overall [8.6 (6.7 - 10.5)/100 PY vs. 5.1 (3.1 - 7)/100 PY, P = 0.01] and IM recurrence rates [5.8 (4.3 - 7.3)/100 PY vs. 3.1 (1.7 - 4)/100 PY, P < 0.01] with no difference in recurrence rates of dysplasia. Significant heterogeneity between studies was identified. The majority of recurrences were amenable to repeat endoscopic eradication therapy (EET).

Conclusion: The results of this study demonstrate that the incidence rates of overall, IM, and dysplasia recurrence rates post-EET are not inconsiderable and reinforce the importance of close surveillance after achieving CE-IM.

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Conflict of interest statement

Competing interests Sachin Wani is supported by the University of Colorado Outstanding Early Scholars Program and AGA Takeda Research Scholar Award in Gastroesophageal Reflux Disease and Barrett’s esophagus. Other author disclosures – Nicholas Shaheen receives research funding from CSA Medical, Covidien, C2 Therapeutics, CDx Medical, and Interpace Diagnostics.

Figures

Fig. 1
Fig. 1
Study flow diagram. *133 full text studies and 6 abstracts.
Fig. 2a
Fig. 2a
Overall pooled incidence of any recurrence (intestinal metaplasia or dysplasia) after achieving complete eradication of intestinal metaplasia following endoscopic eradication therapy using stepwise complete endoscopic resection or radiofrequency ablation with or without focal endoscopic mucosal resection.
Fig. 2b
Fig. 2b
Overall pooled incidence of intestinal metaplasia after achieving complete eradication of intestinal metaplasia following endoscopic eradication therapy using stepwise complete endoscopic resection or radiofrequency ablation with or without focal endoscopic mucosal resection.
Fig. 2c
Fig. 2c
Overall pooled incidence of early neoplasia (EN) after achieving complete eradication of intestinal metaplasia following endoscopic eradication therapy using stepwise complete endoscopic resection or radiofrequency ablation with or without focal endoscopic mucosal resection.
Fig. 3
Fig. 3
Funnel plot for publication bias on the incidence of total recurrence among all studies.
See this image and copyright information in PMC

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