S N van Munster1,2, E A Nieuwenhuis1, B L A M Weusten2,3, L Alvarez Herrero2, A Bogte3, A Alkhalaf4, B E Schenk4, E J Schoon5, W Curvers5, A D Koch6, S E M van de Ven6, P J F de Jonge6, T Tang7, W B Nagengast8, F T M Peters8, J Westerhof8, M H M G Houben9, Jacques J G H M Bergman10, R E Pouw1. 1. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands. 3. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 4. Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands. 5. Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands. 6. Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands. 7. Departmant of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den Ijssel, The Netherlands. 8. Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen University, Groningen, The Netherlands. 9. Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands. 10. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. j.bergman@amsterdamumc.nl.
Abstract
INTRODUCTION: After endoscopic resection (ER) of neoplasia in Barrett's esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. METHODS: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. RESULTS: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11-51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. CONCLUSION: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.
INTRODUCTION: After endoscopic resection (ER) of neoplasia in Barrett's esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. METHODS: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. RESULTS: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11-51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. CONCLUSION: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.
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Authors: Sanne van Munster; Esther Nieuwenhuis; Bas L A M Weusten; Lorenza Alvarez Herrero; Auke Bogte; Alaa Alkhalaf; B E Schenk; Erik J Schoon; Wouter Curvers; Arjun D Koch; Steffi Elisabeth Maria van de Ven; Pieter Jan Floris de Jonge; Tjon J Tang; Wouter B Nagengast; Frans T M Peters; Jessie Westerhof; Martin H M G Houben; Jacques Jghm Bergman; Roos E Pouw Journal: Gut Date: 2021-03-22 Impact factor: 23.059