Aims Radiofrequency ablation(RFA) +/- endoscopic resection(ER) is the standard of care for treatment of Barrett´s esophagus with early neoplasia(BE-neoplasia). We report outcomes for all patients treated in the Netherlands(NL) from 2008-2018, with uniform treatment and follow-up in centralized setting.
Methods Endoscopic therapy for BE-neoplasia in NL is centralized in 9 expert centers with specifically trained endoscopists&pathologists, a joint protocol and a uniform database.
Patients with low/high-grade dysplasia(LGD/HGD) or low-risk adenocarcinoma(EAC) had visible lesions removed by ER, followed by RFA until complete remission of intestinal metaplasia(CR-IM).
FU with HD-endoscopy was initially done every 3months in year-1, followed by yearly endoscopies until year-5, then every 2-3 years. In 2015, endoscopies within year-1 were abandoned. Initially, 4Q-random biopsies(RBx) were obtained from neosquamous epithelium(NSE) and cardia at every FU. These were abandoned in 2013 and 2016, resp.
Results 1,154 patients with median C2M4-BE and LGD(27%), HGD(31%) or EAC(42%) achieved CR-IM. Median FU was 4 (IQR 2-6)years with 4 endoscopies per patient. 370 patients had FU >5years and 112 >8years. 2% was lost to follow-up. 1,114 (97%)patients had sustained CR of neoplasia(SCR-N). 38(3%) developed recurrent neoplasia(14-LGD; 7-HGD; 17-EAC), median 30months after CR-IM. 33/38(87%) were successfully managed endoscopically, 5(0.4% of all pts) progressed to advanced cancer. At baseline, these cases were identified as highly complicated(multifocal HGD/EAC and/or severe reflux stenosis). Overall annual recurrence risk was 0.81%, with a relatively low risk within year-1(0.18%) and >year-5(0.37%). All HGD/EAC recurrences were detected in targeted Bx of visible abnormalities. None of the 13,184 NSE-RBx contributed to neoplasia detection. 9,746 cardia-RBx detected LGD in 9(0.8%) and IM in 124(11%) patients; none of which progressed to HGD/EAC.
Conclusions In a setting of centralized care, the 2-step approach of ER+RFA has remarkably low recurrence rates after CR-IM. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection whilst RBx biopsies can be abandoned.
