RECURRENT NEOPLASIA AFTER ENDOSCOPIC TREATMENT FOR BARRETT’S NEOPLASIA IS RARE: RESULTS FROM A NATIONWIDE COHORT INCLUDING ALL 1,154 PATIENTS TREATED IN THE NETHERLANDS FROM 2008-2018

S van Munster; E.A. Nieuwenhuis; B Weusten; L Alvarez-Herrero; A Bogte; A Alkhalaf; B.E. Schenk; E Schoon; W Curvers; A.D. Koch; S.E.M. van de Ven; P.F.J. de Jonge; T Tang; W.B. Nagengast; F.T.M. Peters; J Westerhof; M.H.M.G. Houben; J.J.G.H.M. Bergman; R.E. Pouw

doi:10.1055/s-0040-1704033

Endoscopy, Table of Contents

Endoscopy 2020; 52(S 01): S8
DOI: 10.1055/s-0040-1704033

ESGE Days 2020 oral presentations

Thursday, April 23, 2020 12:20 – 13:00 President’s opening session 1 Auditorium

RECURRENT NEOPLASIA AFTER ENDOSCOPIC TREATMENT FOR BARRETT’S NEOPLASIA IS RARE: RESULTS FROM A NATIONWIDE COHORT INCLUDING ALL 1,154 PATIENTS TREATED IN THE NETHERLANDS FROM 2008-2018

Authors

S van Munster

¹Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
E.A. Nieuwenhuis

¹Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
B Weusten

²Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands

³UMC Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
L Alvarez-Herrero

²Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
A Bogte

³UMC Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
A Alkhalaf

⁴Isala Hospital, Gastroenterology and Hepatology, Zwolle, Netherlands
B.E. Schenk

⁴Isala Hospital, Gastroenterology and Hepatology, Zwolle, Netherlands
E Schoon

⁵Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
W Curvers

⁵Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
A.D. Koch

⁶Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
S.E.M. van de Ven

⁶Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
P.F.J. de Jonge

⁶Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
T Tang

⁷Ijsselland Hospital, Gastroenterology and Hepatology, Capelle aan den IJssel, Netherlands
W.B. Nagengast

⁸UMC Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
F.T.M. Peters

⁸UMC Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
J Westerhof

⁸UMC Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
M.H.M.G. Houben

⁹Haga Teaching Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
J.J.G.H.M. Bergman

¹Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
R.E. Pouw

¹Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands

Abstract

Full Text

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.