title: Risk of recurrence of Barrett's esophagus after successful endoscopic therapy.
abstract: OBJECTIVE
  Previous estimates of incidence of intestinal metaplasia (IM) recurrence after achieving complete remission of IM (CRIM) through endoscopic therapy of Barrett's esophagus (BE) have varied widely. We performed a systematic review and meta-analysis of studies to estimate an accurate recurrence risk after CRIM.
  
  
  METHODS
  We performed a systematic search of multiple literature databases through June 2015 to identify studies reporting long-term follow-up after achieving CRIM through endoscopic therapy. Pooled incidence rate (IR) of recurrent IM, dysplastic BE, and high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) per person-year of follow-up after CRIM was estimated. Factors associated with recurrence were also assessed.
  
  
  RESULTS
  We identified 41 studies that reported 795 cases of recurrence in 4443 patients over 10,427 patient-years of follow-up. This included 21 radiofrequency ablation studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. Pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC after radiofrequency ablation were 9.5% (95% CI, 6.7-12.3), 2.0% (95% CI, 1.3-2.7), and 1.2% (95% CI, .8-1.6) per patient-year, respectively. When all endoscopic modalities were included, pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC were 7.1% (95% CI, 5.6-8.6), 1.3% (95% CI, .8-1.7), and .8% (95% CI, .5-1.1) per patient-year, respectively. Substantial heterogeneity was noted. Increasing age and BE length were predictive of recurrence; 97% of recurrences were treated endoscopically.
  
  
  CONCLUSIONS
  The incidence of recurrence after achieving CRIM through endoscopic therapy was substantial. A small minority of recurrences were dysplastic BE and HGD/EAC. Hence, continued surveillance after CRIM is imperative. Additional studies with long-term follow-up are needed.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamoorthi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ragunathan
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David
authors.initials: D
authors.lastname: A Katzka
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: K Wang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad
authors.initials: P
authors.lastname: G Iyer
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D057908:Argon Plasma Coagulation; D001471:Barrett Esophagus / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation; D017679:Cryotherapy; D004564:Electrocoagulation; D000069916:Endoscopic Mucosal Resection; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D004945:Esophagoscopy; D006801:Humans; D053685:Laser Therapy; D010778:Photochemotherapy; D011230:Precancerous Conditions / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence