In the Journals

Barrett's esophagus recurrence unlikely after endoscopic eradication with reflux control

Endoscopic eradication therapy with effective reflux control showed durable protection against recurrence of Barrett’s esophagus in a single-center observational cohort study.

“The current research highlights the critical impact of effective reflux control for the outcomes of endoscopic eradication therapy for Barrett’s esophagus,” Srinadh Komanduri, MD, MS, of the division of gastroenterology and hepatology, department of medicine and surgery, Feinberg School of Medicine, Northwestern University, Chicago, told Healio Gastroenterology. “We demonstrated that with tight control of reflux and offering patients anti-reflux surgery when medication is not optimal, recurrence of disease after successful therapy is rare. This has significant impact for patients by allowing for increased intervals between endoscopic surveillance and ultimately ensuring the reduction of cancer risk is sustained.”

Sri Komanduri, MD, MS

Srinadh Komanduri

Komanduri and colleagues evaluated 221 consecutive patients with Barrett’s esophagus who underwent endoscopic eradication therapy between 2008 and 2014, while also being managed under a standardized reflux management protocol that included taking PPIs twice daily (median age, 65 years; 75% men; 96% white). Overall, 46% of the patients had high-grade dysplasia or intramucosal carcinoma, 34% had low-grade dysplasia, and 20% had non-dysplastic Barrett’s esophagus.

Complete eradication of intestinal metaplasia was achieved in 93% of patients and complete eradication of dysplasia was achieved in 96% within 11.6 ± 10.2 months and within a mean of 2.2 ± 1.1 radiofrequency ablation sessions.

However, 48 patients did not achieve complete eradication of intestinal metaplasia in three RFA sessions, but after modifying their reflux management, 93.7% of them achieved complete eradication of intestinal metaplasia within a mean of 1.1 RFA sessions.

Among the 205 patients who achieved complete eradication of intestinal metaplasia, 4.8% experienced recurrence of intestinal metaplasia and 1.5% experienced recurrence of dysplasia throughout a mean follow-up of 44 ± 18.5 months (mean time to recurrence, 18 ± 6.1 months).

Hiatal hernia was the only significant predictor of recurrence (OR = 5.46; 95% CI, 2.27-9.78).

Finally, a comparison of endoscopic eradication therapy under the reflux management protocol vs. historical controls showed recurrence of intestinal metaplasia was significantly lower under reflux management (10.9% vs. 4.8%; P = .04).

“In this setting, [endoscopic eradication therapy] incorporating RFA is highly effective and has long-term durability with minimal early recurrence,” Komanduri and colleagues concluded. “Early recognition of suboptimal reflux control is important for the success of [endoscopic eradication therapy] in practice. These data provide preliminary evidence for potentially extending endoscopic surveillance intervals after [endoscopic eradication therapy].” – by Adam Leitenberger

Disclosures: Komanduri reports he is a consultant for Medtronic and Boston Scientific.