Recommended surveillance intervals following complete eradication of intestinal metaplasia (CE-IM) after endoscopic eradication therapy (EET) are largely not evidence-based. Utilizing recurrence rates in a multicenter international Barrett’s esophagus (BE) CE-IM cohort, we aimed to generate optimal intervals for surveillance.
Patients with dysplastic BE undergoing EET and achieving CE-IM from prospectively maintained databases at five tertiary-care centers in the USA and UK were included. The cumulative incidence of recurrence was estimated, accounting for the unknown date of actual recurrence that lies between the dates of current and previous endoscopy. This cumulative incidence of recurrence was subsequently used to estimate the proportion of patients with undetected recurrence for various surveillance intervals over 5 years. Intervals were selected that minimized recurrences remaining undetected for >6 months. Actual patterns of post CE-IM follow-up were described.
498 patients (with baseline low-grade dysplasia (LGD) 115, high-grade dysplasia (HGD) 288, intramucosal adenocarcinoma (IMCa) 95) were included. Any recurrence occurred in 27.1% and dysplastic recurrence in 8.4% over a median 2.6 years of follow-up. For pre-ablation HGD/IMCa, intervals of 6, 12, 18, 24 months, then annually, resulted in no patients with dysplastic recurrence undetected for >6 months, comparable to current guideline recommendations despite a 33% reduction in number of surveillance endoscopies. For pre-ablation LGD, intervals of 1, 2, and 4 years balanced endoscopic burden and undetected recurrence risk.
Lengthening post CE-IM surveillance intervals would reduce endoscopic burden after CE-IM with comparable rates of recurrent HGD/IMCa. Future guidelines should consider reduced surveillance frequency.

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