A prospective cohort study evaluating disease-specific mortality in patients with early-stage Barrett's esophagus-related neoplasia following endoscopic therapy.

Abstract

BACKGROUND: Endoscopic eradication therapy (EET) for Barrett's esophagus (BE)-related neoplasia is safe and effective in the short term, however there are limited data on long-term outcomes. We aim to provide further evidence on the long-term efficacy of EET in patients with BE-related high-grade dysplasia (HGD) or low-risk T1 esophageal adenocarcinoma (EAC). METHODS: This prospective cohort study enrolled patients with early BE-related neoplasia at a single tertiary referral center between January 2005 and December 2022. We included patients who had a baseline histological diagnosis of HGD, T1a or superficial T1b EAC (invasion into the submucosa less than 500 µ) and received endoscopic therapy with either primary radiofrequency ablation or endoscopic resection (ER). Our primary outcome assessed disease-specific mortality (DSM), which is defined as death following progression to advanced adenocarcinoma not amenable to curative treatment. Secondary outcomes evaluate overall survival, endoscopic recurrence, progression to esophagectomy and major post-procedure complications. RESULTS: We included 330 patients (HGD n = 135; T1a EAC n = 170; T1b EAC n = 25), of which 283 patients were treated with primary endoscopic resection (ER) whereas 47 patients were treated with RFA alone. Median follow up was 55.35 months (IQR 36.5-86.5). DSM was 2.2% (n = 7), with no significant difference between the HGD and EAC groups (p = 0.596). Temporal analysis demonstrated outcome improvement, with 85.7% of DSM cases occurring in the 2005-2014 time period. Five-year overall survival was 88.5%. Endoscopic recurrence was found in 4.2% (n = 14) of patients and 8.8% (n = 29) of patients required surgical intervention. CONCLUSION: In BE-related HGD and early-stage EAC, EET was associated with a low rate of progression to surgery and endoscopic recurrence.