Neoplastic Barrett's oesophagus and long-term follow-up after endoscopic therapy: complete histological eradication of Barrett associated with high-grade dysplasia significantly decreases neoplasia relapse.

Abstract

Endotherapy (ET) has replaced surgery as the first-line treatment of high-grade dysplasia (HGD)/superficial ECA (ECAs) from Barrett's oesophagus (BO). However, long-term follow-up and predictive factors of relapse are not so well studied. The aim of the following study was to evaluate the efficiency of ET for treatment of HGD/ECAs and to determine factors of long-term efficiency. ET procedures were manually reported and registered in a hospital data base from March 2000 to July 2010. Inclusion criteria were HGD/ECA on pre-resection biopsies, complete histological and sufficient oncological resection of HGD/ECAs, and complete macroscopic resection of metaplastic BO. Sixty patients (53 men, mean age=65years) were included. Median follow-up was 66months [range 42-80]. Complete eradication of residual histological metaplastic BO occurred in 29 patients (48%). Relapse rate at 36months was 16.6% (n=10) and was unchanged at 60months of follow-up. There was only one relapse (3.4%) in case of complete eradication of metaplastic BO and 9 (31%) in case of incomplete eradication. In univaried and multi-varied analysis, complete eradication of metaplastic BO (p<0.05) and BO length <5cm (p<0.05) were predictive of neoplastic BO non relapse. The length of BO remained a prognostic factor for disease-free survival (DFS). When these preponderant data were cancelled out in multi-varied analysis, complete eradication of BO was a prognostic factor for DFS (p<0.05). Complete histological eradication of BO by ET significantly decreases the rate of neoplasia relapse.