TY - JOUR
T1 - Analysis of metastases rates during follow-up after endoscopic resection of early “high-risk” esophageal adenocarcinoma
AU - Nieuwenhuis, Esther A.
AU - van Munster, Sanne N.
AU - Dutch Barrett Expert Centers
AU - Meijer, Sybren L.
AU - Brosens, L.
AU - Jansen, Marnix
AU - Weusten, Bas L.A.M.
AU - Alvarez Herrero, Lorenza
AU - Alkhalaf, Alaa
AU - Schenk, Ed
AU - Schoon, Erik J.
AU - Curvers, Wouter L.
AU - Koch, Arjun D.
AU - van de Ven, Steffi E.M.
AU - Verheij, Eva P.D.
AU - Nagengast, Wouter B.
AU - Westerhof, Jessie
AU - Houben, Martin H.M.G.
AU - Tang, Thjon
AU - Bergman, Jacques J.G.H.M.
AU - Pouw, Roos E.
AU - Karrenbeld, A.
AU - Ooms, A.
AU - Huysentruyt, C.
AU - ten Kate, F.
AU - Moll, F.
AU - Kats-Ugurlu, G.
AU - van Lijnschoten, I.
AU - van de Laan, J.
AU - Offerhaus, J.
AU - Biermann, K.
AU - Seldenrijk, K.
AU - Brosens, L.
AU - Meijer, S.
AU - Doukas, M.
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: B. L. A. M. Weusten: Research support from C2 Therapeutics/Pentax Medical and Aqua Medical . J. J. G. H. M. Bergman: Research support from C2 Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. E. J. Schoon: Research support from Fujifilm. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2022 American Society for Gastrointestinal Endoscopy
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background and Aims: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. Methods: For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. Results: One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers. Conclusions: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.
AB - Background and Aims: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. Methods: For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. Results: One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers. Conclusions: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.
UR - https://www.scopus.com/pages/publications/85132381792
U2 - 10.1016/j.gie.2022.03.005
DO - 10.1016/j.gie.2022.03.005
M3 - Article
C2 - 35288149
AN - SCOPUS:85132381792
SN - 0016-5107
VL - 96
SP - 237-247.e3
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 2
ER -
