Effectiveness of Endoscopic Therapy in Patients With Barrettʼs Esophagus (BE) With Early Cancer Is Comparable to That of BE With High-Grade Dysplasia (HGD): Results From an International, Multi-center Consortium: 2017 Category Award (Esophagus)

Abstract

Introduction: Endoscopic therapy, the current treatment of choice for BE patients with HGD, is also a noninvasive alternative to surgery for treatment of BE with intra-mucosal cancer (IMC). There are limited data comparing the outcomes of endoscopic therapy in BE patients with IMC and HGD. We aimed to compare the rates of complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D) and recurrent IM (Re-IM) between the two groups -IMC and HGD.Table: Table. Baseline characteristics and outcomes of endoscopic therapy in IMC and HGDMethods: We reviewed all BE subjects with HGD and IMC who underwent endoscopic therapy in a multicenter prospective registry. Patients were treated with endoscopic mucosal resection if visible lesions were noted and/or mucosal ablation (RFA, cryotherapy, APC) for the flat BE. Patients who underwent at least four EGDs with endoscopic therapy were included in the study. CEIM and CED was defined as histologic absence of intestinal metaplasia (IM) and dysplasia respectively. Re-IM was defined as histologic evidence of BE (IM, dysplasia or esophageal adenocarcinoma (EAC)) after achieving CEIM. Rates of CEIM, CED and Re-IM were calculated for the two study groups - IMC and HGD. Cox proportional hazard models were used to compare the outcomes of endoscopic therapy between the two groups. Results: 276 subjects (70 with IMC and 206 with HGD) with BE who underwent endoscopic therapy were included in the study. The median (IQR) age was 66.0 (58.0, 73.0) years. 232 (84.1%) were males. There were no differences in baseline characteristics (age, sex and BE segment length) between the IMC and HGD groups (table 1). In the IMC group, 57 (81.4%) and 62 (88.6%) subjects achieved CE-IM and CE-D respectively. In the HGD group, 173 (84.0%) and 185 (89.8%) subjects achieved CE-IM and CE-D respectively. There was no statistical difference in the proportion of subjects who achieved CE-IM (P=0.62) and CE-D (P=0.77) in the two groups. On multivariate analysis adjusting for age, sex and BE length, there was no statistical difference in the CE-IM (IMC vs HGD; HR 1.15, 95% CI 0.38 - 3.51, P=0.81) and CE-D (IMC vs HGD; HR 1.21, 95% CI 0.31-4.66, P=0.79) rates between the two groups. There were 25 (43.9%) Re-IM in the IMC group and 60 (34.7%) Re-IM in the HGD group (P=0.21). Conclusion: In this large well-defined cohort of BE patients, effectiveness of endoscopic therapy in IMC is comparable to that of HGD. Consideration of endoscopic therapy in BE patients with early cancer could reduce the need for invasive surgery.