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Neoplastic Barrett’s oesophagus and long-term follow-up after endoscopic therapy: complete histological eradication of Barrett associated with high-grade dysplasia significantly decreases neoplasia relapse

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Abstract

Background and aims

Endotherapy (ET) has replaced surgery as the first-line treatment of high-grade dysplasia (HGD)/superficial ECA (ECAs) from Barrett’s oesophagus (BO). However, long-term follow-up and predictive factors of relapse are not so well studied. The aim of the following study was to evaluate the efficiency of ET for treatment of HGD/ECAs and to determine factors of long-term efficiency.

Methods

ET procedures were manually reported and registered in a hospital data base from March 2000 to July 2010. Inclusion criteria were HGD/ECA on pre-resection biopsies, complete histological and sufficient oncological resection of HGD/ECAs, and complete macroscopic resection of metaplastic BO. Sixty patients (53 men, mean age = 65 years) were included.

Results

Median follow-up was 66 months [range 42–80]. Complete eradication of residual histological metaplastic BO occurred in 29 patients (48 %). Relapse rate at 36 months was 16.6 % (n = 10) and was unchanged at 60 months of follow-up. There was only one relapse (3.4 %) in case of complete eradication of metaplastic BO and 9 (31 %) in case of incomplete eradication. In univaried and multi-varied analysis, complete eradication of metaplastic BO (p < 0.05) and BO length <5 cm (p < 0.05) were predictive of neoplastic BO non relapse. The length of BO remained a prognostic factor for disease-free survival (DFS). When these preponderant data were cancelled out in multi-varied analysis, complete eradication of BO was a prognostic factor for DFS (p < 0.05).

Conclusion

Complete histological eradication of BO by ET significantly decreases the rate of neoplasia relapse.

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Authors and Affiliations

  1. Endoscopy Unit, Paoli Calmettes Institute, Marseille, France

    Fabrice Caillol, Sebastien Godat, Erwan Bories, Christian Pesenti, Jean Phillippe Ratone & Marc Giovannini

  2. Statistic Unit, Paoli Calmettes Institute, Marseille, France

    Aurelie Autret

  3. Pathology Unit, Paoli Calmettes Institute, Marseille, France

    Flora Poizat

  4. Surgery Unit, Paoli Calmettes Institute, Marseille, France

    Jerome Guiramand & Jean Robert Delpero

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  1. Fabrice Caillol
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Correspondence to Fabrice Caillol.

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Disclosures

Dr. Fabrice Caillol, Dr. Sebastien Godat, Miss Aurelie Autret, Dr. Erwan Bories, Dr. Christian Pesenti, Dr. Jean Phillippe Ratone, Dr. Flora Poizat, Dr. Jerome Guiramand, Pr. Jean Robert Delpero, Dr. Marc Giovannini have no conflicts of interest or financial ties to disclose.

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Caillol, F., Godat, S., Autret, A. et al. Neoplastic Barrett’s oesophagus and long-term follow-up after endoscopic therapy: complete histological eradication of Barrett associated with high-grade dysplasia significantly decreases neoplasia relapse. Surg Endosc 30, 5410–5418 (2016). https://doi.org/10.1007/s00464-016-4898-6

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