Endoscopic eradication therapy (EET) is guideline endorsed for management of early-stage (T1) esophageal adenocarcinoma (EAC). Patients with baseline high grade dysplasia (HGD) and EAC are at highest risk of recurrence following successful EET, but limited data exist on long-term (> 5 year) recurrence outcomes. We aimed to assess the incidence and predictors of long-term recurrence in a multicenter cohort of T1EAC patients treated with EET.
Patients with T1 EAC achieving successful endoscopic cancer eradication with a minimum of 5-years clinical follow-up were included. The primary outcome was neoplastic recurrence, defined as dysplasia or EAC, and was characterized as early (5 years). Predictors of recurrence were assessed by time to event analysis.
84 T1 EAC patients (75 T1a, 9 T1b) with a median 9.1 years (range 5.1-18.3 years) of follow-up were included. The overall incidence of neoplastic recurrence was 2.0/100 patient years of follow up. 7 recurrences (3 dysplasia, 4 EAC) occurred after 5 years of EAC remission. 88% of recurrences were treated successfully endoscopically. EAC recurrence-related mortality occurred in 3 patients at a median of 5.2 years from EAC remission. Complete eradication of intestinal metaplasia (CE-IM) was independently associated with reduced recurrence (HR 0.13).
Following successful EET of T1 EAC, neoplastic recurrence occurred after 5 years in 8.3% of cases. Careful long-term surveillance should be continued in this patient population. CE-IM should be the therapeutic endpoint for EET.
Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
