title: Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett's esophagus.
abstract: BACKGROUND
  Endoscopic therapy is the preferred approach for the management of Barrett's esophagus (BE) patients with high-grade dysplasia (HGD) and intramucosal carcinoma (IMC). Little is known about outcome differences in patients with HGD versus IMC.
  
  
  OBJECTIVE
  To determine and compare the rate of recurrent dysplasia or neoplasia in patients with HGD or IMC undergoing endoscopic therapy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 246 BE patients with either HGD or IMC referred for endoscopic therapy.
  
  
  METHODS
  Patients underwent EMR and/or ablation therapy with the goal of complete eradication of all dysplasia/neoplasia and intestinal metaplasia (CE-IM). Patients were assigned to either the HGD or IMC group based on highest pathology grade at the start of therapy.
  
  
  METHODS
  Complete eradication and recurrence of IM and/or HGD/neoplasia were assessed among patients with HGD versus IMC. Only patients with CE-IM (documented eradication of all dysplasia/neoplasia and IM on a single endoscopy) were included for analysis of recurrence rates and risk factors.
  
  
  RESULTS
  CE-IM was achieved in 113 of 135 patients (83.7%) with HGD and in 84 of 111 patients (75.7%) with IMC (P = .16). Overall recurrence rates of dysplasia or neoplasia after CE-IM were similar in both groups (HGD, 8.0% vs IMC, 9.5%; P = .44; relative risk, 1.2; 95% confidence interval, 0.5-3.0) and remained similar in patients with 5 years of surveillance after CE-IM (HGD, 13.5% vs IMC, 11.4%; P = .53; relative risk, 0.85; 95% confidence interval, 0.3-2.7).
  
  
  CONCLUSIONS
  Retrospective, observational study and evolution of endoscopic modalities and experience.
  
  
  CONCLUSIONS
  Endoluminal therapy can successfully achieve eradication of IM and dysplasia or neoplasia in BE patients with HGD and IMC at comparable rates. There were no differences in the rates of recurrent HGD/IMC in the 2 groups.
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Aaron J
authors: AJ
authors: Small
authors: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Scott E
authors: SE
authors: Sutherland
authors: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Jessica S
authors: JS
authors: Hightower
authors: Gastroenterology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Carlos
authors: C
authors: Guarner-Argente
authors: Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Emma E
authors: EE
authors: Furth
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Wilmott Center for Endoscopic Innovation, Research, and Training.
authors: Michael L
authors: ML
authors: Kochman
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Kimberly A
authors: KA
authors: Forde
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Meenakshi
authors: M
authors: Bewtra
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Gary W
authors: GW
authors: Falk
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Gregory G
authors: GG
authors: Ginsberg
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010778:Photochemotherapy; D011230:Precancerous Conditions / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies