title: Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus.
abstract: BACKGROUND
  The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined.
  
  
  OBJECTIVE
  To determine the rate and predictors of dysplasia/neoplasia recurrence after photodynamic therapy (PDT) in BE.
  
  
  METHODS
  Retrospective analysis of a prospective cohort of BE patients seen at a specialized BE unit.
  
  
  METHODS
  Patients underwent a standard protocol assessment with esophagogastroduodenoscopy and 4-quadrant biopsies every centimeter at 3-month intervals after ablation. Recurrence was defined as the appearance of any grade of dysplasia or neoplasia after 2 consecutive endoscopies without dysplasia. Entry histology, demographics, length of BE, presence and length of diaphragmatic hernia, EMR, stricture formation, nonsteroidal anti-inflammatory drug use, smoking, and the presence of nondysplastic BE or squamous epithelium were assessed for univariate associations. Time-to-recurrence analysis was done by using Cox proportional hazards regression. A multivariate model was constructed to establish independent associations with recurrence.
  
  
  RESULTS
  A total of 363 patients underwent PDT with or without EMR. Of these, 261 patients were included in the final analysis (44 lost to follow-up, 46 had residual dysplasia, and 12 had no dysplasia at baseline). Indication for ablation was low-grade dysplasia (53 patients, 20%), high-grade dysplasia (152 patients, 58%), and intramucosal cancer (56 patients, 21%). Median follow-up was 36 months (interquartile range 18-79 months). Recurrence occurred in 45 patients. Median time to recurrence was 17 months (interquartile range 8-45 months). Significant predictors of recurrence on the multivariate model were older age (hazard ratio [HR] 1.04, P=.029), presence of residual nondysplastic BE (HR 2.88, P=.012), and a history of smoking (HR 2.68, P=.048).
  
  
  CONCLUSIONS
  Possibility of missing prevalent dysplasia despite aggressive surveillance.
  
  
  CONCLUSIONS
  Recurrence of dysplasia/neoplasia after PDT ablation is associated with advanced age, smoking, and residual BE.
authors: Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Rami J
authors: RJ
authors: Badreddine
authors: Ganapathy A
authors: GA
authors: Prasad
authors: Kenneth K
authors: KK
authors: Wang
authors: Louis M Wong Kee
authors: LM
authors: Song
authors: Navtej S
authors: NS
authors: Buttar
authors: Kelly T
authors: KT
authors: Dunagan
authors: Lori S
authors: LS
authors: Lutzke
authors: Lynn S
authors: LS
authors: Borkenhagen
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006414:Hematoporphyrin Photoradiation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors