Endoscopy 2021; 53(S 01): S31
DOI: 10.1055/s-0041-1724333
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Thursday, 25 March 2021 18:00 – 18:45 Barrett’s and beyond Room 6

Neoplastic Recurrence After Successful Treatment For Early Barrett’s Neoplasia: Development of a Penalized Prediction Model

SN van Munster
1   Amsterdam University Medical Centers, Location VUmc, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
EA Nieuwenhuis
1   Amsterdam University Medical Centers, Location VUmc, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
BLAM Weusten
2   University Medical Center Utrecht, Utrecht University, Gastroenterology and Hepatology, Utrecht, Netherlands
3   Sint Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
,
L Alvarez Herrero
3   Sint Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
,
A Bogte
2   University Medical Center Utrecht, Utrecht University, Gastroenterology and Hepatology, Utrecht, Netherlands
,
A Alkhalaf
4   Isala Clinics, Gastroenterology and Hepatology, Zwolle, Netherlands
,
BE Schenk
4   Isala Clinics, Gastroenterology and Hepatology, Zwolle, Netherlands
,
E Schoon
5   Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
,
WL Curvers
5   Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
,
AD Koch
6   Erasmus MC University Medical Center Rotterdam, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
PJ de Jonge
6   Erasmus MC University Medical Center Rotterdam, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
T Tang
7   Ijsselland Hospital, Gastroenterology and Hepatology, Capelle a/d Ijssel, Netherlands
,
WB Nagengast
8   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
J Westerhof
8   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
MHMG Houben
9   Haga Teaching Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
,
JJGHM Bergman
1   Amsterdam University Medical Centers, Location VUmc, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
RE Pouw
1   Amsterdam University Medical Centers, Location VUmc, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
Dutch Barrett Expert Centers › Author Affiliations
 
 

    Aims Endoscopic resection (ER) +/- radiofrequency ablation (RFA) is the treatment of choice for Barrett’s esophagus (BE) with early neoplasia. Since long-term outcomes are limited, patients still undergo regular follow-up endoscopies after successful treatment (ie,complete eradication of BE, CE-BE). We aimed to develop a prediction model for recurrence, which can be used for personalized follow-up.

    Methods We collected data from the Dutch Barrett Expert Center Registry, a nationwide registry that captures outcomes from all BE patients that underwent endoscopic treatment for early BE-neoplasia in expert centers. Recurrence was defined as histologic finding of low-grade dysplasia(LGD), high-grade dysplasia(HGD) or esophageal adenocarcinoma(EAC) during endoscopic follow-up. We built a prognostic survival model taking account of competing risks (i.e,Fine and Gray) with LASSO penalization. We assessed: age, gender, baseline pathology, BE-length, new visible lesion(s)(VL) during ablation, poor healing, persisting esophagitis, number of ablation endoscopies, number of ER endoscopies, persisting IM in cardia.

    Results

    All patients (n = 1154)

    No recurrence (n = 1116)

    Recurrence (n = 38)

    Univariable analysis - Hazard ratio [95 %CI]

    LASSO model - Hazard ratio

    Max. BE length, cm, mean±SD

    5 ± 3

    7 ± 3

    1,18 [1,12;1,26]

    1,16

    Baseline HGD/EAC, n (%)

    814 (73)

    34 (90)

    2,52 [0,89;7,09]

    1,41

    Number of ER endoscopies, median (IQR)

    1 (0-1)

    1 (0-1)

    1,63 [1,17;2,26]

    1,18

    New visible lesion(s) during ablation phase, n (%)

    62 (6)

    9 (24)

    4,34 [2,05;9,31]

    2,85

    1,154 patients were included with a mean endoscopic follow-up of 4 years (±2) per patient. Overall, 38 patients developed recurrence (0.8 %/person year[95 %CI 0.6-1.1]; LGD n = 14(37 %); HGD n = 13(34 %); EAC n = 17(45 %)). Following characteristics were independently associated with recurrence (strongest-weakest): new VLs during ablation, higher number of ER-endoscopies, increasing BE-length, HGD/EAC at baseline, younger age, male. The internally validated C-statistic was 0,76[95 %-CI 0,73; 0,79]. For example, a 50y male with 10cm BE with EAC and 3 ER sessions including 1 for a new VL during RFA, had a cumulative risk for recurrence of 48 % during 7y. In contrast, a 70y female with 3cm BE with flat LGD, had 3 % risk.

    Conclusions We built the first prediction model for recurrence after successful treatment of early neoplastic BE in a centralized setting, with good discrimination. If external validation confirms its predictive power, this model can help clinicians and patients to manage expectations and determine a personalized follow-up strategy.

    Citation: van Munster SN, Nieuwenhuis EA, Weusten BLAM et al. OP74 NEOPLASTIC RECURRENCE AFTER SUCCESSFUL TREATMENT FOR EARLY BARRETT’S NEOPLASIA: DEVELOPMENT OF A PENALIZED PREDICTION MODEL. Endoscopy 2021; 53: S31.


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    Publication History

    Article published online:
    19 March 2021

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