Late recurrence of Barrett’s esophagus after complete eradication of intestinal metaplasia is rare

A study in the latest issue of Gastroenterology finds that late recurrence of Barrett’s esophagus after complete eradication of intestinal metaplasia is rare.

The goal of treatment for Barrett’s esophagus with dysplasia is complete eradication of intestinal metaplasia.

The long-term durability of complete eradication of intestinal metaplasia has not been well characterized, so the frequency and duration of surveillance are unclear.

Dr Nicholas Shaheen and colleagues from North Carolina, USA report results from a 5-year follow-up analysis of patients with Barrett’s esophagus and dysplasia treated by radiofrequency ablation in the randomized controlled Ablation of Intestinal Metaplasia Containing Dysplasia (AIM) trial.

Participants for the AIM Dysplasia trial were recruited from 19 sites in the United States and had endoscopic evidence of non-nodular dysplastic Barrett’s esophagus ≤8 cm in length.

Subjects were randomly assigned to receive either radiofrequency ablation or a sham endoscopic procedure; patients in the sham group were offered radiofrequency ablation treatment 1 year later, and all patients were followed for 5 years.

92% achieved complete eradication of intestinal metaplasia

Gastroenterology

The researchers collected data on Barrett’s esophagus recurrence and dysplastic Barrett’s esophagus recurrence among patients who achieved complete eradication of intestinal metaplasia.

The team constructed Kaplan-Meier estimates and applied parametric survival analysis to examine proportions of patients without any recurrence and without dysplastic recurrence.

Of 127 patients in the AIM Dysplasia trial, 119 received radiofrequency ablation and met inclusion criteria.

Of those 119, 92% achieved complete eradication of intestinal metaplasia.

Over 401 person-years of follow-up, 32% of patients had recurrence of Barrett’s esophagus or dysplasia, and 17% had dysplasia recurrence.

The incidence rate of Barrett’s esophagus recurrence was 11 per 100 person-years overall; 8 per 100 person-years among patients with baseline low-grade dysplasia, and 14 per 100 person-years among patients with baseline high-grade dysplasia.

The team found that the incidence rate of dysplasia recurrence was 5 per 100 person-years overall, of which 3 per 100 person-years among patients had baseline low-grade dysplasia, and 7 per 100 person-years among patients had baseline high-grade dysplasia.

Neither Barrett’s esophagus nor dysplasia recurred at a constant rate.

There was a greater probability of recurrence in the first year following complete eradication of intestinal metaplasia than in the following 4 years combined.

Dr Sheehan's team concludes, "In this analysis of prospective cohort data from the AIM Dysplasia trial, we found Barrett's esophagus to recur after complete eradication of intestinal metaplasia by radiofrequency ablation in almost one third of patients with baseline dysplastic disease; most recurrences occurred during the first year after complete eradication of intestinal metaplasia."

"However, patients who achieved complete eradication of intestinal metaplasia and remained Barrett’s esophagus free at 1 year after radiofrequency ablation had a low risk of Barrett’s esophagus recurrence."

"Studies are needed to determine when surveillance can be decreased or discontinued; our study did not identify any Barrett’s esophagus or dysplasia recurrence after 4 years of surveillance."