Follow-up endoscopy after Barrett's esophagus fix could be curbed

Last Updated: 2018-04-27

By David Douglas

NEW YORK (Reuters Health) - Neoplasia recurrence following initially successful radiofrequency ablation (RFA) of Barrett's esophagus (BE) is relatively rare and endoscopic follow-up frequency may be safely reduced in many patients, researchers say.

"Endoscopy utilization is a 'big-ticket item,' and entails a significant effort and investment on the part of the patient," Dr. Nicholas J. Shaheen of the University of North Carolina School of Medicine, in Chapel Hill, told Reuters Health by email.

"Our data," he added, "suggest that a much attenuated schedule of follow-up endoscopies after successful treatment of Barrett's esophagus would still provide good protection against the development of cancer. These data are the first guidance for this problem that is not based on expert opinion."

For the study, online April 6 in Gastroenterology, Dr. Shaheen and colleagues collected and analyzed data from U.S. and U.K. registries involving more than 5,800 patients.

To predict the incidence of neoplasia recurrence following initially successful RFA, they developed three categories of risk and modeled intervals which would yield a 0.1% risk of recurrence of invasive adenocarcinoma.

Recurrence was associated with the most severe histologic grade prior to complete eradication of intestinal metaplasia (CEIM), age, endoscopic mucosal resection, sex and baseline BE segment length.

Using U.S. registry data, multivariate analysis with a model based solely on most severe pre-CEIM histology predicted neoplastic recurrence with a C statistic of 0.892. The model also performed well using U.K. data, the team says.

Based on the findings, they say, "For patients with low-grade dysplasia, we propose surveillance endoscopy at 1 and 3 years after CEIM; for patients with high-grade dysplasia or intramucosal adenocarcinoma we propose surveillance endoscopy at 0.25, 0.5, and 1 year after CEIM, then annually."

Adherence to these surveillance intervals "could decrease the number of endoscopies performed yet identify unresectable cancers at rates less than 1/1000 endoscopies," the researchers write.

"Our findings suggest the frequency of surveillance endoscopies after CEIM should differ broadly from what is currently recommended and rely only on most severe histologic grade before CEIM is achieved," they observe.

Dr. Yujin Hoshida of the Simmons Comprehensive Cancer Center of The University of Texas Southwestern Medical Center, in Dallas, who was not involved in the study, told Reuters Health by email, "Given the sizable patient population and lengthy follow-up to monitor neoplastic recurrence, individual risk-based tailored screening is a promising approach to enable cost-effective and practically-feasible implementation of a cancer/neoplasia screening program."

SOURCE: https://bit.ly/2HTxqhY

Gastroenterology 2018.