RECURRENCE FOLLOWING COMPLETE ERADICATION OF INTESTINAL METAPLASIA OF BARRETT´S ESOPHAGUS AFTER ENDOSCOPIC THERAPY IN A SPANISH REFERRAL CENTER

Aims Endoscopic Therapy of Barrett´s esophagus (BE) with Radiofrecuency Ablation (RFA) and Endoscopic Mucosal Resection (EMR) is effective to achieve complete eradication of intestinal metaplasia (CEIM). Long-term rate of CEIM is not establish longer than 5 years so surveillance in these patients is unclear. Studies report a 20% recurrence rate of Intestinal Metaplasia (IM) after 2-3 years of CEIM. There are not cases published with Dysplasia or cancer after 4 years of CEIM.

We assessed the rates for disease recurrence of Low Grade Dysplasia (LGD), High Grade Dysplasia (HGD) or Intramucosal cancer (IMC) after CEIM in patients with BE treated with RFA and/or EMR, the time of the recurrence and the therapy used.

Methods We performed a retrospective cohort study of 118 patients with BE and LGD, HGD or IMC treated with RFA and/or EMR that achieve CEIM between 2007 and 2017 and underwent subsequent endoscopic surveillance at a single center. Rates of disease recurrence and progression were determined and also the therapy used and its efficacy.

Results Seven patients (6% of those with CEIM) had a recurrent disease with LGD in 5, HGD in 1 and IMC in 1 after a median of 29 months (interquartile ranges (IR) 12´5-58´0 months). RFA was performed in 4, EMR in 2 (in 1 EMR was used twice) and RFA and EMR in 1 patient. CEIM was achieved in 6 and 1 patient died for other reason.

Conclusions There is BE recurrence of Dysplasia in patients that achieved CEIM after more than 4 years of surveillance. Endoscopic treatment is feasible if reappears. Endoscopic follow up in these cases should continue because late recurrence can occur after years.