Download PDF
Endoscopy 2022; 54(10): 927-933
DOI: 10.1055/a-1765-7197
Original article

Threshold evaluation for optimal number of endoscopic treatment sessions to achieve complete eradication of Barrett’s metaplasia

Chetan Mittal 
1   Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, United States
,
V. Raman Muthusamy
2   Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California, United States
,
Violette C. Simon
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Brian C. Brauer
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Daniel K. Mullady
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Thomas Hollander
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Ian Sloan
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Vladimir Kushnir
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Dayna Early
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Amit Rastogi
5   Division of Gastroenterology, Kansas University, Kansas City, Kansas, United States
,
Hazem T. Hammad
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Steven A. Edmundowicz
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Samuel Han
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Adarsh M. Thaker
2   Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California, United States
,
Ezenwanyi Ezekwe
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Sachin Wani
3   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Mary J. Kwasny
1   Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, United States
,
Srinadh Komanduri
1   Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Referred to by:

Timelines for successful endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: what are we aiming for?Endoscopy 2022; 54(10): 934-935
DOI: 10.1055/a-1904-7988

Abstract

Background Endoscopic eradication therapy (EET) is the standard of care for Barrett’s esophagus (BE)-associated neoplasia. Previous data suggest the mean number of EET sessions required to achieve complete eradication of intestinal metaplasia (CE-IM) is 3. This study aimed to define the threshold of EET sessions required to achieve CE-IM.

Methods The TREAT-BE Consortium is a multicenter outcomes cohort including prospectively enrolled patients with BE undergoing EET. All patients achieving CE-IM were included. Demographic, endoscopic, and histologic data were recorded at treatment onset along with treatment details and surveillance data. Kaplan–Meier analysis was performed to define a threshold of EET sessions, with 95 %CI, required to achieve CE-IM. A secondary analysis examined predictors of incomplete response to EET using multiple logistic regression and recurrence rates.

Results 623 patients (mean age 65.2 [SD 11.6], 79.6 % male, 86.5 % Caucasian) achieved CE-IM in a mean of 2.9 (SD 1.7) EET sessions (median 2) and a median total observation period of 2.7 years (interquartile range 1.4–5.0). After three sessions, 73 % of patients achieved CE-IM (95 %CI 70 %–77 %). Age (odds ratio [OR] 1.25, 95 %CI 1.05–1.50) and length of BE (OR 1.24, 95 %CI 1.17–1.31) were significant predictors of incomplete response.

Conclusion The current study found that a threshold of three EET sessions would achieve CE-IM in the majority of patients. Alternative therapies and further diagnostic testing should be considered for patients who do not have significant response to EET after three sessions.

Supplementary material



Publication History

Received: 16 October 2020

Accepted: 08 February 2022

Accepted Manuscript online:
08 February 2022

Article published online:
04 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Spechler S, Souza R. Barrett’s esophagus. N Engl J Med 2014; 371: 836-845
    Search in Google Scholar
  • 2 Hvid-Jensen F, Pederson L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 1375-1383
    CrossrefPubMedSearch in Google Scholar
  • 3 Rastogi A, Puli S, El-Serag HB. et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc 2008; 67: 394-398
    CrossrefPubMedSearch in Google Scholar
  • 4 Bhat S, Coleman H, Yousef H. et al. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011; 103: 1049-1057
    CrossrefPubMedSearch in Google Scholar
  • 5 Wani S, Falk GW, Post J. et al. Risk factors for progression of low-grade dysplasia in patients with Barrett’s esophagus. Gastroenterology 2011; 141: 1179-1186
    CrossrefPubMedSearch in Google Scholar
  • 6 Wani S, Qumseya B, Sultan S. et al. Endoscopic eradication therapy for patients with Barrett’s esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc 2018; 87: 907-931
    CrossrefPubMedSearch in Google Scholar
  • 7 Desai M, Gupta N, Vennalaganti P. et al. Efficacy and safety of multi-modality endoscopic therapy in Barrett’s esophagus-(BE) related neoplasia: a systematic review with pooled-data analysis. Gastroenterology 2015; 148: S402
    CrossrefPubMedSearch in Google Scholar
  • 8 Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11: 1245-1255
    Search in Google Scholar
  • 9 Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
    CrossrefPubMedSearch in Google Scholar
  • 10 Sharma P, Parasa S, Shaneen N. et al. Developing quality metrics for upper endoscopy. Gastroenterology 2020; 158: 9-13
    CrossrefPubMedSearch in Google Scholar
  • 11 Sawas T, Alsawas M, Bazerbachi F. et al. Persistent intestinal metaplasia after endoscopic eradication therapy of neoplastic Barrett’s esophagus increases the risk of dysplasia recurrence: meta-analysis. Gastrointest Endosc 2019; 8: 913-925
    CrossrefPubMedSearch in Google Scholar
  • 12 Desai M, Saligram S, Gupta N. et al. Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic review and pooled analysis. Gastrointest Endosc 2017; 85: 482-495
    Search in Google Scholar
  • 13 Wani S, Han S, Kushnir V. et al. Recurrence is rare following complete eradication of intestinal metaplasia in patients with Barrett’s esophagus and peaks at 18 months. Clin Gastroenterol Hepatol 2020; 18: 2609-2617
    Search in Google Scholar
  • 14 Omar M, Thaker A, Wani S. et al. Anatomic location of Barrett’s esophagus recurrence after endoscopic eradication therapy: development of a simplified surveillance biopsy strategy. Gastrointest Endosc 2019; 90: 395-403
    Search in Google Scholar
  • 15 Komanduri S, Kahrilas K, Krishnan K. et al. Recurrence of Barrett’s esophagus is rare following endoscopic eradication therapy coupled with effective reflux control. Am J Gastroenterol 2017; 112: 556-566
    Search in Google Scholar
  • 16 Pasricha S, Bulsiewicz WJ, Hathorn KE. et al. Durability and predictors of successful radiofrequency ablation for Barrett’s esophagus. Clin Gastroenterol Hepatol 2014; 12: 1840-1847
    Search in Google Scholar
  • 17 Krishnan K, Pandolfino JE, Kahrilas PJ. et al. Increased risk for persistent intestinal metaplasia in patients with Barrett’s esophagus and uncontrolled reflux exposure before radiofrequency ablation. Gastroenterology 2012; 143: 576-581
    CrossrefPubMedSearch in Google Scholar
  • 18 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C& M criteria. Gastroenterology 2006; 131: 1392-1399
    CrossrefPubMedSearch in Google Scholar
  • 19 Li N, Pasricha S, Bulsiewicz WJ. et al. Effects of preceding endoscopic mucosal resection on the efficacy and safety of radiofrequency ablation for treatment of Barrett’s esophagus: results from the United States Radiofrequency Ablation Registry. Dis Esophagus 2016; 29: 537-543
    CrossrefPubMedSearch in Google Scholar
  • 20 Phoa K, Pouw RE, Bisschops R. et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of a European multicenter study (EURO-II). Gut 2016; 65: 555-562
    Search in Google Scholar
  • 21 Haidry R, Butt M, Dunn J. et al. Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett’s oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry. Gut 2015; 64: 1192-1199
    CrossrefPubMedSearch in Google Scholar