Long-term outcomes after endoscopic eradication therapy for dysplastic and T1a adenocarcinoma-related Barrett's esophagus: higher rate of late dysplastic recurrence with radiofrequency ablation monotherapy

Abstract

Background and aims: There is conflicting literature describing the durability of complete remission of intestinal metaplasia (CRIM) after endoscopic eradication therapy for Barrett's esophagus (BE). The aim of this study was to assess the timeline, predictors, and long-term outcomes of recurrence.

Methods: Data on 365 patients who underwent endoscopic eradication therapy for dysplastic BE were collected prospectively between 2008 and 2022 at a Barrett's referral unit. Kaplan-Meier method and Epanechnikov kernel density estimate were used to determine the cumulative incidence of recurrence after CRIM and the rate of recurrence over time. A logistic regression analysis was fitted to identify factors associated with recurrence.

Results: A total of 216 patients achieved CRIM and were then followed up for a median (IQR) 5.8 years (2.9-7.2 years). Intestinal metaplasia (IM) recurred in 57 patients (26.4%) and dysplasia in 18 patients (8.3%). The time to recurrence peaked at 1.8 years. The cumulative recurrence risk within 2 years was 23.1% with an additional 29.2% risk over the next 10 years. Increased risks of any BE recurrence (odds ratio, 3.0; P = .009), dysplastic (relative risk ratio [RRR], 5.53; P = .001), and late (≥2 years) recurrences (RRR, 3.24; P = .01) were associated with radiofrequency ablation (RFA) monotherapy, whereas combination EMR and RFA were associated with a decreased risk of dysplastic recurrence (RRR, .27; P = .02).

Conclusions: The risk of recurrence is highest within the first 2 years post-CRIM but remains significant long term. The risk of IM, dysplasia, and late recurrence was higher when RFA was the sole modality used to achieve CRIM, raising the possibility that RFA provides a less durable response. These findings may affect treatment and surveillance decisions.