title: Recurrent disease following endoscopic ablation of Barrett's high-grade dysplasia with spray cryotherapy.
abstract: OBJECTIVE
  Recurrent disease after endoscopic ablation of Barrett's esophagus should be detected early to prevent malignant progression. We assessed the incidence and patterns of disease recurrence in patients after liquid nitrogen spray cryotherapy ablation of Barrett's esophagus with high grade dysplasia (HGD), including the area below the neosquamocolumnar junction (NSCJ).
  
  
  METHODS
  This is a single-center, retrospective study of prospectively collected data on consecutive cases of endoscopic ablation with liquid nitrogen spray cryotherapy for Barrett's HGD. Post-treatment surveillance biopsies were obtained of suspicious lesions and in 4 quadrants every 1 cm in the treated esophagus and just below the NSCJ. Primary outcome measures were location and histology of recurrent disease.
  
  
  RESULTS
  36 patients (median age 62 years, 92% men) were enrolled, and 11 (30%) developed recurrent disease in a median of 6.5 months; three developed a second recurrence. Ten recurrences (71%) were identified below the NSCJ in 9 patients, including HGD (4), low grade dysplasia (LGD) (2), and intestinal metaplasia (4). Six recurrences were identified in the treated esophagus in five patients, including intramucosal cancer (1), HGD (1), and intestinal metaplasia (4). Two patients had recurrent disease involving both locations. Ultimately 33 patients (92%) achieved a complete response. Diagnosis in the remaining three was LGD (1) and intestinal metaplasia (2).
  
  
  CONCLUSIONS
  Most patients with recurrent intestinal metaplasia with or without dysplasia after ablation achieve a complete response. Recurrent disease commonly involves the area just below the NSCJ. Surveillance endoscopies should include this area to accurately identify patients with disease recurrence.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Halsey
authors.forename: J W
authors.initials: JW
authors.lastname: Chang
authors.forename: A
authors.initials: A
authors.lastname: Waldt
authors.forename: B D
authors.initials: BD
authors.lastname: Greenwald
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D002471:Cell Transformation, Neoplastic; D003452:Cryosurgery; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies