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• W3032987945 abstract "Patients with Barrett’s esophagus (BE) who achieve complete eradication of intestinal metaplasia (CEIM) undergo continued surveillance for recurrent dysplasia. Most recurrences of dysplasia occur at or near the GE junction. Recurrent intestinal metaplasia at the gastroesophageal junction (GEJIM) without dysplasia is a common finding but with unclear clinical significance. The aim of this study was to determine whether recurrent GEJIM is associated with an increased risk of future dysplasia, and whether re-treatment of recurrent GEJIM lowers the risk of future dysplasia. We performed a retrospective analysis of a multi-center cohort of BE patients treated with endoscopic eradication therapy (EET) who achieved CEIM, defined as ≥1 exam with no endoscopic BE and no IM or dysplasia on biopsies from the GEJ and esophagus. Follow-up exams were performed at standard post-ablation intervals with biopsies taken from the GEJ on each endoscopy. Recurrent GEJIM was defined as non-dysplastic IM on GEJ biopsies without endoscopic evidence of BE. Patients were categorized as no recurrent GEJIM (“never GEJIM”); recurrent GEJIM but not treated (“GEJIM observed”), or recurrent GEJIM followed by GEJ re-treatment (“GEJIM treated”). The primary outcome was development of low grade dysplasia or worse histology. Analyses were performed using log-rank tests and Cox proportional hazards modeling. A total of 518 patients were analyzed, and median follow-up time was 48 months (IQR 27-73). Most (80%) patients had high grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) pre-treatment. The annual incidence of any grade dysplasia recurrence was 2.4%/year. No patient characteristics were associated with recurrent GEJIM. (TABLE) GEJIM observed patients were significantly less likely to progress to dysplasia compared to never GEJIM patients (p=0.03), and there was no difference in the rate of dysplasia recurrence comparing GEJIM observed to GEJIM treated patients (p=0.22). (FIGURE) Study site (but no patient characteristics) was associated with treatment of recurrent GEJIM. In multivariate analysis, compared to never GEJIM patients, the risk of dysplasia recurrence was significantly lower in GEJIM observed patients (aHR 0.21, 95% 0.05-0.91) and not different in GEJIM treated patients (aHR 0.83, 95% CI 0.38-1.79). Independent predictors of dysplasia recurrence included baseline HGD or IMC (aHR 3.77, 95% 1.33-10.7) and hiatal hernia size (per cm, aHR 1.20, 95% 1.06-1.36). After successful EET, recurrent GEJIM that was observed was associated with a low risk of future dysplasia. Also, treatment of recurrent GEJIM was not associated with a further reduction in the risk of recurrent dysplasia. These data suggest that recurrent non-dysplastic IM at the GEJ may not be a concerning finding and observation may be appropriate.FigureRecurrence of LGD or worse after achieving CEIM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3032987945 date "2020-06-01" @default.
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• W3032987945 title "Mo1248 RECURRENCE OF GASTRO-ESOPHAGEAL JUNCTION INTESTINAL METAPLASIA AFTER ENDOSCOPIC ERADICATION OF BARRETT'S ESOPHAGUS IS NOT ASSOCIATED WITH INCREASED RATES OF DYSPLASIA RECURRENCE: RESULTS OF A MULTI-CENTER COHORT STUDY" @default.
• W3032987945 doi "https://doi.org/10.1016/j.gie.2020.03.2442" @default.
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