Tu1538 Relationship Between Baseline Histology and Recurrence Histology After Successful Endoscopic Ablation for Barrett's Esophagus

Abstract

Tu1538 Relationship Between Baseline Histology and Recurrence Histology After Successful Endoscopic Ablation for Barrett’s Esophagus Karthik Ragunathan*, Rajesh Krishnamoorthi, Sairaman Nagarajan, Prasad G. Iyer Dept of Internal Medicine, University of Illinois College of medicine, Peoria, IL, Peoria, IL; Mayo Clinic, Rochester, MN; Harvard university, Boston, MA Background: Several studies have reported risk of recurrence of Barrett’s esophagus (BE) after achieving complete remission of intestinal metaplasia (CRIM) through endotherapy. Recurrence risk after CRIM in non-dysplastic BE (NDBE) subjects undergoing ablation versus those with LGD, HGD or IMC (dysplastic BE, D-BE) is unclear. Additionally, the relationship between baseline histology and recurrence histology has not been studied. We aimed to study these relationships through a systematic review and meta-analysis. Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through July, 2014) to identify cohort studies reporting the recurrence of IM, dysplasia and/or esophageal adenocarcinoma (EAC) after CRIM following endotherapy for Barrett’s related neoplasia. We excluded studies which 1) with cohorts consisting of a combination of D-BE and NDBE patients, 2) did not report baseline and recurrence histology, and 3) did not report follow up duration after CRIM. Studies were categorised into Dysplastic group (low grade, high grade and/ or EAC) and Nondysplastic group based on baseline histology. Dysplastic recurrence (DR) was defined as recurrence of BE with dysplasia (LGD or HGD) or EAC after CRIM. Non Dysplastic recurrence (NDR)was defined as recurrence of BE without dysplasia after CRIM. Risk of dysplastic recurrence (RDR) was defined as difference between DR and NDR. Primary outcome was RDR in dysplastic and non-dysplastic groups. Results: A total of 12 studies were included with 7 studies in dysplastic group(118 recurrences in 676 patients with 1282.35 patient years of follow up) and 5 studies in nondysplastic group(39 recurrences in 360 patients with 2159.83 years of follow up).The pooled IR in the dysplastic and non-dysplastic group was 7.4 % per patient year (95% CI of 0.59-0.89) and was 0.7% per patient year(95% CI of 0.3-1.0) respectively. RDR in the dysplastic group and non dysplastic group was 0.04(95% CI -0.05 to 0.13) and -0.11(95%CI -0.14 to -0.07) respectively (Figure 1 and 2). Conclusion: Recurrence rates after endoscopic therapy in BE subjects with baseline dysplasia undergoing endoscopic therapy is about 10 times the rate in the NDBE patients. Given the higher rates of recurrence and possibility of dysplastic recurrence, D-BE patients should stay in long term surveillance after CRIM. Conversely, given the lower rates of recurrence and high likelihood of recurrence histology to be NDBE, surveillance intervals in NDBE patients could potentially be lengthened.