%0 Journal Article
%T Long-term outcomes following successful endoscopic treatment of T1 esophageal adenocarcinoma: a multicenter cohort study.
%A Kahn A
%A Song K
%A Dhaliwal L
%A Thanawala S
%A Hagen CE
%A Agarwal S
%A McDonald NM
%A Gabre JT
%A Falk GW
%A Ginsberg GG
%A Wolfsen HC
%A Ramirez FC
%A Leggett CL
%A Wang KK
%A Iyer PG
%J Gastrointest Endosc
%V 98
%N 5
%D 2023 Nov 24
%M 37356631
%F 10.396
%R 10.1016/j.gie.2023.06.012
%X <B>OBJECTIVE: </B>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 after successful EET, but limited data exist on long-term (>5 year) recurrence outcomes. Our aim was to assess the incidence and predictors of long-term recurrence in a multicenter cohort of patients with T1 EAC treated with EET.<BR><B>METHODS: </B>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 it was characterized as early (<2 years), intermediate (2-5 years), or late (>5 years). Predictors of recurrence were assessed by time to event analysis.<BR><B>RESULTS: </B>A total of 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 per 100 person-years of follow-up. Seven recurrences (3 dysplasia, 4 EAC) occurred after 5 years of EAC remission. Overall, 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 was independently associated with reduced recurrence (hazard ratio, .13).<BR><B>CONCLUSIONS: </B>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. Complete eradication of intestinal metaplasia should be the therapeutic end point for EET.