TY - JOUR
T1 - Clinical Relevance of Random Biopsies From the Esophagogastric Junction After Complete Eradication of Barrett's Esophagus is Low
AU - Frederiks, Charlotte N.
AU - van Munster, Sanne N.
AU - Nieuwenhuis, Esther A.
AU - Alvarez Herrero, Lorenza
AU - Alkhalaf, Alaa
AU - Schenk, Boudewijn E.
AU - Schoon, Erik J.
AU - Curvers, Wouter L.
AU - Koch, Arjun D.
AU - de Jonge, Pieter-Jan F.
AU - Tang, Thjon
AU - Nagengast, Wouter B.
AU - Westerhof, Jessie
AU - Dutch Barrett Expert Centers
AU - Houben, Martin H. M. G.
AU - Bergman, Jacques J. G. H. M.
AU - Pouw, Roos E.
AU - Weusten, Bas L. A. M.
N1 - Funding Information: Conflicts of interest These authors disclose the following: Charlotte Frederiks has received speaker's fees from Pentax Medical. Jacques Bergman is a consultant for Medtronic, Cook Medical, and Boston Scientific; and has received financial support for institutional review board-approved research from Pentax Medical, Medtronic, and Aqua Medical. Roos Pouw is a consultant for MicroTech; and has received speaker's fees from Medtronic. Bas Weusten has received financial support for institutional review board-approved research from Pentax Medical. The remaining authors disclose no conflicts. Publisher Copyright: © 2023 The Authors
PY - 2023/8
Y1 - 2023/8
N2 - Background & Aims: Although random histological sampling from the esophagogastric junction (EGJ) after complete eradication of Barrett's esophagus (BE) is recommended, its clinical relevance is questionable. This study aimed to assess the incidence and long-term outcomes of findings from random EGJ biopsies in a nationwide cohort with long-term follow-up. Methods: We included all patients with successful endoscopic eradication therapy (EET), defined as complete endoscopic eradication of all visible BE (CE-BE), for early BE neoplasia from the Dutch registry. Patients were treated and followed-up in 9 expert centers according to a joint protocol. Outcomes included the incidence of intestinal metaplasia (IM) at the EGJ (EGJ-IM) and the association between IM and visible (dysplastic) BE recurrence. Results: A total of 1154 patients were included with a median follow-up of 43 months (interquartile range, 22–69 months). At the time of CE-BE, persisting EGJ-IM was found in 7% of patients (78/1154), which was reproduced during further follow-up in 46% of patients (42/78). No significant association existed between persisting EGJ-IM at CE-BE and recurrent non-dysplastic or dysplastic BE (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.63–2.13 and HR, 0.73; 95% CI, 0.17-3.06, respectively). Among patients with no EGJ-IM at the time of CE-BE (1043/1154; 90%), EGJ-IM recurred in 7% (72/1043) after a median of 21 months (interquartile range, 15–36 months), and was reproduced during further follow-up in 26% of patients (19/72). No association was found between recurrent EGJ-IM and non-dysplastic or dysplastic recurrence (HR, 1.18; 95% CI, 0.67–2.06 and HR, 0.27; 95% CI, 0.04–1.96, respectively). Conclusion: Because EGJ-IM was not associated with a higher risk for recurrent disease, we recommend to consider abandoning random EGJ sampling after successful EET, under the condition that care is provided in expert centers, and the esophagus, including the EGJ, is carefully inspected (Netherlands Trial Register, NL7309).
AB - Background & Aims: Although random histological sampling from the esophagogastric junction (EGJ) after complete eradication of Barrett's esophagus (BE) is recommended, its clinical relevance is questionable. This study aimed to assess the incidence and long-term outcomes of findings from random EGJ biopsies in a nationwide cohort with long-term follow-up. Methods: We included all patients with successful endoscopic eradication therapy (EET), defined as complete endoscopic eradication of all visible BE (CE-BE), for early BE neoplasia from the Dutch registry. Patients were treated and followed-up in 9 expert centers according to a joint protocol. Outcomes included the incidence of intestinal metaplasia (IM) at the EGJ (EGJ-IM) and the association between IM and visible (dysplastic) BE recurrence. Results: A total of 1154 patients were included with a median follow-up of 43 months (interquartile range, 22–69 months). At the time of CE-BE, persisting EGJ-IM was found in 7% of patients (78/1154), which was reproduced during further follow-up in 46% of patients (42/78). No significant association existed between persisting EGJ-IM at CE-BE and recurrent non-dysplastic or dysplastic BE (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.63–2.13 and HR, 0.73; 95% CI, 0.17-3.06, respectively). Among patients with no EGJ-IM at the time of CE-BE (1043/1154; 90%), EGJ-IM recurred in 7% (72/1043) after a median of 21 months (interquartile range, 15–36 months), and was reproduced during further follow-up in 26% of patients (19/72). No association was found between recurrent EGJ-IM and non-dysplastic or dysplastic recurrence (HR, 1.18; 95% CI, 0.67–2.06 and HR, 0.27; 95% CI, 0.04–1.96, respectively). Conclusion: Because EGJ-IM was not associated with a higher risk for recurrent disease, we recommend to consider abandoning random EGJ sampling after successful EET, under the condition that care is provided in expert centers, and the esophagus, including the EGJ, is carefully inspected (Netherlands Trial Register, NL7309).
KW - Barrett's Esophagus
KW - Endoscopic Eradication Therapy
KW - Radiofrequency Ablation
KW - Random Biopsies
UR - http://www.scopus.com/inward/record.url?scp=85147361420&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85147361420&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36423874
U2 - https://doi.org/10.1016/j.cgh.2022.11.012
DO - https://doi.org/10.1016/j.cgh.2022.11.012
M3 - Article
C2 - 36423874
SN - 1542-3565
VL - 21
SP - 2260-2269.e9
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 9
ER -