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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(06): E430-E449
DOI: 10.1055/s-0043-106578
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis[*]

Authors

  • Larissa L. Fujii-Lau   **

    1   Washington University School of Medicine, St. Louis, MO, USA

  • Birtukan Cinnor   **

    2   University of Colorado Anschutz Medical Campus, Aurora, CO, USA

  • Nicholas Shaheen

    3   University of North Carolina, Chapel Hill, NC, USA

  • Srinivas Gaddam

    1   Washington University School of Medicine, St. Louis, MO, USA

  • Srinadh Komanduri

    4   Feinberg School of Medicine Northwestern University, Chicago, IL, USA

  • V. Raman Muthusamy

    5   University of California, Los Angeles, Los Angeles, CA, USA

  • Ananya Das

    6   Arizona Center for Digestive Health, Gilbert, AZ, USA

  • Robert Wilson

    2   University of Colorado Anschutz Medical Campus, Aurora, CO, USA

  • Violette C. Simon

    2   University of Colorado Anschutz Medical Campus, Aurora, CO, USA

  • Vladimir Kushnir

    1   Washington University School of Medicine, St. Louis, MO, USA

  • Daniel Mullady

    1   Washington University School of Medicine, St. Louis, MO, USA

  • Steven A. Edmundowicz

    2   University of Colorado Anschutz Medical Campus, Aurora, CO, USA

  • Dayna S. Early

    1   Washington University School of Medicine, St. Louis, MO, USA

  • Sachin Wani

    2   University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Further Information

Publication History

submitted 22 November 2016

accepted after revision 15 February 2017

Publication Date:
31 May 2017 (online)

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Abstract

Background Conflicting data exist with regard to recurrence rates of intestinal metaplasia (IM) and dysplasia after achieving complete eradication of intestinal metaplasia (CE-IM) in Barrett’s esophagus (BE) patients.

Aim (i) To determine the incidence of recurrent IM and dysplasia achieving CE-IM and (ii) to compare recurrence rates between treatment modalities [radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) vs stepwise complete EMR (SRER)].

Methods A systematic search was performed for studies reporting on outcomes and estimates of recurrence rates after achieving CE-IM. Pooled incidence [per 100-patient-years (PY)] and risk ratios with 95 %CI were obtained. Heterogeneity was measured using the I 2 statistic. Subgroup analyses, decided a priori, were performed to explore heterogeneity in results.

Results A total of 39 studies were identified (25-RFA, 13-SRER, and 2 combined). The pooled incidence of any recurrence was 7.5 (95 %CI 6.1 – 9.0)/100 PY with a pooled incidence of IM recurrence rate of 4.8 (95 %CI 3.8 – 5.9)/100 PY, and dysplasia recurrence rate of 2.0 (95 %CI 1.5 – 2.5)/100 PY. Compared to the SRER group, the RFA group had significantly higher overall [8.6 (6.7 – 10.5)/100 PY vs. 5.1 (3.1 – 7)/100 PY, P = 0.01] and IM recurrence rates [5.8 (4.3 – 7.3)/100 PY vs. 3.1 (1.7 – 4)/100 PY, P < 0.01] with no difference in recurrence rates of dysplasia. Significant heterogeneity between studies was identified. The majority of recurrences were amenable to repeat endoscopic eradication therapy (EET).

Conclusion The results of this study demonstrate that the incidence rates of overall, IM, and dysplasia recurrence rates post-EET are not inconsiderable and reinforce the importance of close surveillance after achieving CE-IM.

* Results of this study were presented in part at Digestive Disease Week 2015, Washington, DC, USA


** Drs Fujii-Lau and Cinnor contributed equally to this manuscript and are joint first authors.