Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona.
Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida.
Clin Gastroenterol Hepatol. 2022 Dec;20(12):2763-2771.e3. doi: 10.1016/j.cgh.2022.02.043. Epub 2022 Mar 1.
BACKGROUND & AIMS: Recommended surveillance intervals after complete eradication of intestinal metaplasia (CE-IM) after endoscopic eradication therapy (EET) are largely not evidence-based. Using 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 5 tertiary-care centers in the United States and the United Kingdom 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 subsequently was 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 more than 6 months. Actual patterns of post-CE-IM follow-up evaluation are described.
A total of 498 patients (with baseline low-grade dysplasia, 115 patients; high-grade dysplasia [HGD], 288 patients; and intramucosal adenocarcinoma [IMCa], 95 patients) were included. Any recurrence occurred in 27.1% and dysplastic recurrence occurred in 8.4% over a median of 2.6 years of follow-up evaluation. For pre-ablation HGD/IMCa, intervals of 6, 12, 18, and 24 months, and then annually, resulted in no patients with dysplastic recurrence undetected for more than 6 months, comparable with current guideline recommendations despite a 33% reduction in the number of surveillance endoscopies. For pre-ablation low-grade dysplasia, intervals of 1, 2, and 4 years balanced endoscopic burden and undetected recurrence risk.
Lengthening post-CE-IM surveillance intervals would reduce the endoscopic burden after CE-IM with comparable rates of recurrent HGD/IMCa. Future guidelines should consider reduced surveillance frequency.
内镜下根除治疗（EET）后完全消除肠化生（CE-IM）后的推荐监测间隔时间在很大程度上没有依据。本研究利用多中心国际 Barrett 食管（BE）CE-IM 队列中的复发率，旨在为监测生成最佳间隔时间。
纳入在美国和英国的 5 家三级护理中心的前瞻性维护数据库中接受 EET 且实现 CE-IM 的存在异型增生的 BE 患者。估计复发的累积发生率，考虑到实际复发日期位于当前和之前内镜检查日期之间的未知日期。随后，使用该复发累积发生率来估计在 5 年内各种监测间隔时间下未检测到复发的患者比例。选择那些使超过 6 个月未检测到的复发比例最小的间隔时间。描述了 CE-IM 后随访评估的实际模式。
共纳入 498 例患者（低级别异型增生 115 例，高级别异型增生[HGD]288 例，黏膜内腺癌[IMCa]95 例）。中位随访 2.6 年后，任何部位复发的发生率为 27.1%，异型增生复发的发生率为 8.4%。对于术前 HGD/IMCa，间隔 6、12、18 和 24 个月，然后每年一次，可使超过 6 个月未检测到异型增生复发的患者数为零，与当前指南推荐相当，尽管监测内镜检查的数量减少了 33%。对于术前低级别异型增生，间隔 1、2 和 4 年可平衡内镜负担和未检测到的复发风险。
延长 CE-IM 后监测间隔时间可在保持可比的 HGD/IMCa 复发率的情况下减轻 CE-IM 后的内镜负担。未来的指南应考虑减少监测频率。
