title: Long-term recurrence of neoplasia and Barrett's epithelium after complete endoscopic resection.
abstract: BACKGROUND
  Current endoscopic therapy for neoplastic Barrett's oesophagus (BO) consists of complete resection/ablation of all Barrett's tissue including neoplastic lesions. Recurrence seems to be frequent after thermal therapy, such as radiofrequency ablation.
  
  
  OBJECTIVE
  To analyse long-term recurrence of neoplasia and BO after successful widespread endoscopic mucosal resection (EMR).
  
  
  METHODS
  In a retrospective analysis, all patients undergoing widespread EMR of neoplastic BO between 2002 and 2007 at two referral centres were followed for at least 3 years after completion of endotherapy. Recurrence was diagnosed if neoplasia and/or BO were detected following previous successful complete removal, defined as at least two negative endoscopies and biopsies.
  
  
  RESULTS
  Ninety patients undergoing widespread EMR were included (mean age 63 years; 82 male), 58% of whom underwent additional thermal ablation for minor residual disease. Complete eradication of neoplasia and Barrett's tissue was achieved in 90% of patients. On further follow-up (mean 64.8 months), recurrence of neoplastic and non-neoplastic BO was found in 6.2% and 39.5%, respectively. Recurring neoplasia (3 adenocarcinomas, 1 low-grade and 1 high-grade dysplasia) were found after a median of 44 months (range 38-85) and could be retreated endoscopically. In a multivariate analysis, Barrett's length was the only factor significantly associated with recurrence (OR 2.73).
  
  
  CONCLUSIONS
  Even after seemingly complete endoscopic resection, recurrence of BO is frequent and independent of additional thermal therapy. Due to the possibility of neoplasia recurrence even after long disease-free intervals, follow-up should be extended beyond 5 years.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Anders
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bähr
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Division of Gastroenterology, Department of Internal Medicine, Assiut University, Assiut, Egypt.
authors.forename: Muhammad Abbas
authors.initials: MA
authors.lastname: El-Masry
authors.affiliation: Department of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Marx
authors.affiliation: Department of Pathology, Charité University Hospital, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Gastrozentrum, Hirslanden Clinic, Zürich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schachschal
authors.affiliation: Department of Gastroenterology, Charité University Hospital, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Adler
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
authors.affiliation: Department of Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Izbicki
authors.affiliation: Department of Surgery, Charité University Hospital, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.affiliation: VA Medical Center, White River Junction, Vermont, USA.
authors.forename: Heiko
authors.initials: H
authors.lastname: Pohl
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Barrett's Carcinoma; Barrett's Oesophagus; Endoscopy