Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

SN van Munster, EA Nieuwenhuis, BLAM Weusten, LA Herrero, A Bogte, A Alkhalaf, BE Schenk, EJ Schoon, W Curvers, Arjun Koch, Steffi van de Ven, Pieter Jan de Jonge, T Tang, WB Nagengast, FT Peters, J Westerhof, MHMG Houben, JJGHM Bergman, RE Pouw

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Introduction: After endoscopic resection (ER) of neoplasia in Barrett’s esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. Methods: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. Results: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11–51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. Conclusion: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number1
Publication statusPublished - 2021

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