{Reference Type}: Journal Article
{Title}: Long-term outcomes following successful endoscopic treatment of T1 esophageal adenocarcinoma: a multicenter cohort study.
{Author}: Kahn A;Song K;Dhaliwal L;Thanawala S;Hagen CE;Agarwal S;McDonald NM;Gabre JT;Falk GW;Ginsberg GG;Wolfsen HC;Ramirez FC;Leggett CL;Wang KK;Iyer PG;
{Journal}: Gastrointest Endosc
{Volume}: 98
{Issue}: 5
{Year}: 2023 Nov 24
{Factor}: 10.396
{DOI}: 10.1016/j.gie.2023.06.012
{Abstract}: <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.