482 NEW QUALITY MEASURES FOR ENDOSCOPIC ERADICATION THERAPY IN BARRETT’S ESOPHAGUS: IS 18 MONTHS AN APPROPRIATE TARGET TO ACHIEVE COMPLETE ERADICATION?

Abstract

The ASGE and ACG recently published proposed quality measures for endoscopic eradication therapy (EET) for Barrett’s esophagus (BE). Many of these measures were based on expert opinion rather than evidence of improved patient outcomes. One particular measure suggested that complete eradication of intestinal metaplasia (CE-IM) should be achieved in 70% of patients within 18 months of initiating EET. The purpose of this study was to assess whether an 18-month timeline to achieve this endpoint is associated with improved long-term clinical outcomes. A retrospective single-center cohort study was performed of patients who underwent EET for BE between 2006 and 2017. Patients were included in analyses if CE-IM had been achieved or if CE-IM had not been achieved and an endoscopy had been performed at least 18 months since initiating EET. Data on patient characteristics, baseline BE histology, BE length, and hiatal hernia size were recorded. Treatment received, complications, and follow up data were recorded, including recurrence and progression dates, locations, and histology. CE-IM was defined as a single endoscopy after initiation of EET that demonstrated no endoscopic evidence of BE and no evidence of intestinal metaplasia on biopsies. Proportions and means or medians were calculated to summarize data. The Kaplan-Meier method was used to compare recurrence rates. Multivariable Cox proportional hazards modeling was used to identify predictors of recurrence. A total of 291 BE patients were treated with EET, had sufficient follow-up, and were included in the analyses. (TABLE) The majority (74.2%) had baseline histology of high-grade dysplasia (HGD) or intramucosal adenocarcinoma. CE-IM was achieved in 86.3% of patients, with a median time to CE-IM of 13.0 months (IQR 7.9-22.1), and required a median of 3 treatments (IQR 2-5). Only 68.9% of patients who achieved CE-IM did so within 18 months. Less severe baseline histology and shorter BE length were predictors of achieving CE-IM within 18 months. The median follow-up time after CE-IM was 34.2 months (IQR 12.6-63.2). Comparing those who achieved CE-IM within 18 months to those with longer time to CE-IM, there were no differences in the rate of recurrence of IM (log-rank p=0.29) or dysplasia (log-rank p=0.79) (FIGURE), even after adjusting for potential confounders. At the end of follow-up, among patients who achieved CE-IM, four (5.5%) had HGD or cancer; all of these subjects had achieved CE-IM within 18 months. There is no evidence that an 18-month cutoff to achieve CE-IM in BE patients undergoing EET is associated with improved long-term outcomes. Consideration should be given to modifying proposed quality measures for EET in BE based on outcomes data.Tabled 1Characteristics of BE patients who underwent EETTotal291Age, mean63.9 yrs (SD 10.5)Male sex233 (80.1%)White race252 (86.6%)BE length, median (cm)3 cm (IQR 1-5)Hiatal hernia size, median (cm)2 cm (IQR 1-3)Baseline Histology:No dysplasia25 (8.6%)Indefinite for dysplasia9 (3.1%)Low grade dysplasia41 (14.1%)High grade dysplasia161 (55.3%)Intramucosal EAC55 (18.9%) Open table in a new tab